BLADDER CANCER OVERVIEW
Cancer of the urinary bladder is one of the most common cancers. The most common type of bladder cancer in the United States and Western Europe is urothelial carcinoma, also known as transitional cell carcinoma. The optimal treatment for urothelial bladder cancer depends on the cancer’s stage and grade (which describes how aggressive it appears under the microscope), as well as on the person’s health.
- Approximately 70 percent of all new cases of bladder cancer are classified as non-muscle invasive (previously called “superficial”). The initial treatment for non-muscle-invasive bladder cancer is a procedure called “transurethral resection of bladder tumor,” or TURBT. This is sometimes followed by additional therapy, which reduces the chances of the cancer recurring.
- The remaining 30 percent are muscle-invasive bladder cancers, and they generally require surgical removal of the entire bladder. This is often combined with preoperative or postoperative chemotherapy.
In some cases, the cancer can be successfully treated without removing the entire bladder.
WHAT IS INVASIVE BLADDER CANCER?
Bladder tumors are staged using the TNM system, which stands for “tumor,” “node,” and “metastasis.” The stage indicates how deeply the tumor has penetrated the bladder wall (T stage), whether it has reached the lymph nodes that drain the bladder (N stage), and whether it has metastasized or spread to other parts of the body (M stage). All of this information is then used to categorize the cancer into a “stage group” between 0 (least advanced) and IV (most advanced); this helps the doctor to decide on a treatment approach.
Invasive bladder cancer is stage T1 or greater, which means that the tumor has invaded the lining of the bladder. T1 designates tumors that have invaded the superficial (surface) lining of the bladder but not the muscle layer. If the tumor has invaded the muscle layer of the bladder but not deeper, it is stage T2. Stage T3 cancer has grown through the bladder muscle into the fat layer surrounding the bladder, while stage T4 cancer has grown directly into nearby organs.
BLADDER CANCER TREATMENT OPTIONS
The standard treatment for muscle-invasive bladder cancer includes surgery to remove the bladder (called radical cystectomy).Radical cystectomy requires the creation of a new way to get rid of urine.For people with muscle-invasive bladder cancer who are able to tolerate more aggressive treatment, chemotherapy is often given before or, in some cases, after surgery.
Which treatment is best?
The best treatment for invasive bladder cancer depends on the stage of your cancer as well as your age, health, other medical conditions, and personal preference. When possible, surgical removal of the bladder is preferred because it is associated with a lower chance of cancer recurrence and a higher chance of survival compared with other treatments. However, preserving the bladder may be an option in selected cases.
Where will the urine go?
After your bladder is removed, the surgeon must create a new place for urine to be collected inside the body. This is called a “urinary diversion.” All options involve using a segment of bowel, which is removed from the small or large intestine. After removing a segment of bowel, the intestines are reattached so that they function normally. The section of bowel that is removed is cleaned and prepared.
There are several possible options at this point:
- Urine can be diverted through a segment of bowel to the skin’s surface, where an opening (called a stoma) is created. A bag is attached to the stoma to collect the urine. This is called an ileal conduit or non-continent cutaneous diversion.
- A reservoir (like a pouch) may be created under the skin of the abdomen using tissue from the intestines. Urine collects in the pouch, and you use a catheter (a thin tube) to empty the pouch periodically. It is not necessary to wear a bag. This is called a continent cutaneous diversion, and the most common type is called an Indiana pouch.
- A new bladder may be created from a segment of bowel. The new bladder is connected to the urethra (the tube through which urine exits the body), allowing the person to urinate normally. This is called an orthotopic neobladder (commonly called a neobladder), and the Studer neobladder is the most common type.
The “best” type of urinary diversion depends on your and your surgeon’s preference as well as the extent of your cancer. The reservoir and neobladder may require learning how to self-catheterize; people who would have difficulty handling or placing the catheter may not be good candidates for these procedures.
Potential complications of urinary diversion include leakage of urine, urinary tract infection, skin irritation (with the stoma or pouch), and narrowing or closure of the opening where urine leaves the body. The risk of each of these depends on which type of urinary diversion is performed. Your surgeon can talk to you in more detail about the risks and benefits of each type of diversion.
Surgical complications :
Complications are possible after radical cystectomy and urinary diversion. The most common serious complications include infection, wound opening, bleeding, and blood clots in the lungs (pulmonary embolism). The surgeon and hospital’s experience in performing cystectomy, as well as your age and any underlying medical problems, affect your risk of developing complications.Following surgery, it is very important to follow all your doctors’ instructions about rest and recovery.