Bladder Cancer Surgery

Up to eighty percent of all bladder cancers are diagnosed as superficial bladder cancers. Once positively diagnosed and biopsied, many superficial bladder cancers (SBC) can be surgically removed by a procedure known as a transurethral resection of a bladder tumor, or TURBT. For invasive bladder cancer more aggressive therapy (cystectomy or bladder removal) is necessary to stop its progression to metastatic bladder cancer.

Transurethral Resection of Bladder Cancer (TURBT)

The TURBT is the most conservative surgery for bladder cancer. Still, it has some side effects including possible bleeding and infection, perforation of the bladder, and blocked ureters.

Transurethral resection generally takes place in the hospital with the patient under general anesthesia. The doctor inserts a cystoscope, a small, lit camera, in through the urethra and into the bladder. A small tool with a wire loop at the end is inserted through the cystoscope. A high-frequency electric current passes through the wire tool removing and burning cancer cells. This method is called fulguration. In some situations, fulguration will not be enough to eradicate the tumor.

In superficial bladder cancers that recur following TURBT, the doctor will use a laser to obliterate the tumor. However, because laser surgery also destroys surrounding tissue, if the tumor has not been previously biopsied and positively diagnosed as bladder cancer, its use is not recommended.

Follow-up to TURBT: Transurethral resection is often a successful treatment for patients with low-risk cancers. These cancers are described as noninvasive, papillary cancers. The noninvasive characteristic keeps them from penetrating into deeper layers of tissue but does not prevent their recurrence. Up to seventy percent of patients with superficial bladder cancer have some recurrence within five years of treatment. Therefore, follow-up therapy is an important part of post transurethral resection therapy.

Follow-up therapy includes a cystoscopic evaluation three months after the initial TURBT treatment and then every six months for an additional year. If cancer reappears, follow-up cystoscopy and urinalysis is typically performed every three months for the first year and every six months for an additional three to five years.

Partnering Chemotherapy with TURBT: Patients with high-risk tumors those that are likely to become invasive may benefit from the TURBT procedure but may need other “adjuvant ” treatment. Because of the relatively high chance of progressing (thirty percent), high risk bladder cancers are often treated with transurethral resection combined with intravesical therapy. Intravesical therapy is a type of chemotherapy or immunotherapy instilled directly into the bladder.

Cystectomy: Bladder Surgery for Invasive Bladder Cancer Once cancer cells have penetrated the muscular layer of the bladder the stage is referred to as invasive cancer. Invasive bladder cancer (IBC) cannot be treated with TURBT or intravesical therapy.

The most common mode of therapy for invasive bladder cancer is the surgical removal of the bladder a procedure known as a radical cystectomy. A radical cystectomy also includes the removal of the nearby lymph nodes, and part of the urethra. In men it may include the removal of the prostate, seminal vesicles and vas deferens. In women, it may include the removal of the ovaries, fallopian tubes and part of the vagina. Any area in direct contact with the cancer cells is removed to prevent the cancer from spreading to other parts of the body.

As with any surgery, a radical cystectomy may have side effects. Some patients may experience sexual dysfunction, salt imbalances, bone loss, or deterioration of the kidney.

Preservation of the Bladder

Although the best statistics for survival of invasive bladder cancer are associated with radical cystectomy, bladder removal eliminates the reservoir for urine storage and a new bladder must be constructed. Each patient is evaluated for the most appropriate method according to general health, age and extent of surgery.

Sometimes, a new bladder can be made out of part of the intestines. These are called orthotopic neobladders and allow patients to have close to normal urinary function. Some patients will require a pouch on the outside of the body to hold urine. This is known as an ostomy. The ostomy attaches to a stoma, or opening in the body created for the excretion of urine. Patients requiring an ostomy receive education and support from medical personnel about care of the affected area.

New Options for Treatment

Researchers are looking to other modes of therapy to preserve the bladder. New studies indicate some value in trimodality therapy. This therapy involves combining three therapies: transurethral resection, radiation, and systemic chemotherapy. Other treatments involve the use of chemotherapy drugs along with surgical procedures to keep a partial bladder intact. Clinical trials help researchers find new ways to treat invasive bladder cancer.

Resources

Beers, M. H.,