Items Tagged With Bladder Cancer

• Partial cystectomy is the removal of part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area. Partial cystectomy is only a good choice if the cancer is not near the openings where urine enters or leaves the bladder.
• Radical cystectomy is the removal of the entire bladder, nearby lymph nodes (lymphadenectomy), part of the urethra, and nearby organs that may contain cancer cells.
  • In men, the prostate, the seminal vesicles, and part of the vas deferens are also removed.
  • In women, the cervix, the uterus, the ovaries, the fallopian tubes, and part of the vagina are also removed.

Preoperative testing may include CT scan of the pelvis, abdomen, and chest, as well as a barium enema or colonoscopy. Sometimes the doctor will also recommend a cardiac stress test before surgery.

Regional lymph nodes may be removed (lymphadenectomy) during cystectomy. Removing lymph nodes helps your doctor determine whether cancer is present in the lymph nodes and provides more accurate information about the stage of the cancer.

What To Expect After Surgery

Cystectomy usually requires a hospital stay of at least 3 to 7 days. You can expect some discomfort during the first few days after surgery. This discomfort is usually controllable with home treatment and medication. Complete recovery usually takes 6 to 8 weeks.

Following surgery to remove the bladder, your surgeon will create a new channel for urine to pass from your body.¹

• An ileal conduit (also called a noncontinent diversion) uses a segment of your intestine to create a channel that connects your ureters to a surgically created opening (stoma) on your abdomen. This procedure is called a urostomy. After a urostomy, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin. You will empty the bag 3 or 4 times a day, and a larger bag that allows for longer storage can be worn overnight. You will also learn how to care for your urostomy.
• A continent reservoir (continent diversion) uses a segment of your intestine to create a storage pouch that is attached inside your abdomen. There are two types of internal continent reservoirs.
  • Abdominal diversion reservoir. The pouch inside the abdomen connects to an opening (stoma) in the skin (urostomy). This opening is smaller than the opening for an ileal conduit. And because there is a pouch inside the abdomen, no bag needs to be worn outside your body. You will need to pass a catheter through the opening to release the urine several times a day and during the night.
  • Orthotopic diversion. The pouch in this procedure is sometimes called a bladder substitution reservoir. If your urethra was not removed as part of the cystectomy, you may be able to have this type of procedure. In an orthotopic diversion, the pouch is attached to your ureters at one end and your urethra at the other. This allows you to pass urine through the same opening as you did before surgery. Some people may need to use a catheter to release the urine.

Additional treatment may be needed following a radical cystectomy and may include radiation therapy or chemotherapy. Biological therapy may be used after a partial cystectomy for early-stage tumors.

Follow-up for a partial cystectomy includes cystoscopy and urinary exams every 3 to 6 months for at least 2 years, with regular ultrasound, intravenous pyelogram (IVP), or CT scans of the pelvis and abdomen.

Why It Is Done

Cystectomy is used to remove and attempt to cure cancer that has invaded the wall of the bladder or has come back (recurred) following initial treatment or has a high chance of spreading.

How Well It Works

About 75% of people who have a cystectomy for bladder cancer in the muscle of the bladder are disease-free after 5 years. People with more deeply invasive bladder cancer have a 5-year survival rate of 30% to 50% after cystectomy.²

Risks

Complications are common after a radical cystectomy and may include:^{1, 3}

• Acidosis. This in an imbalance in electrolytes such as calcium and potassium. It can be caused by using a part of the intestine to divert urine after a cystectomy. People with acidosis often need to take medicine to control it.
• Urine leak.
• Infection.
• Fistula formation.
• Bowel obstruction.
• Rectal injury.

Cystectomy can also lead to erection problems if nerves are damaged during surgery.⁴ For more information, see the topic Erection Problems.

What To Think About

You may donate your own blood (autologous blood donation) to use during surgery if needed. If you choose to do this, start the donations several weeks before the surgery so that you have time to donate enough blood and rebuild your blood volume before surgery.

In the past, cystectomy done on men usually removed the nerves that control erections. Now nerve-sparing procedures may be used to avoid damaging the nerves that run alongside the prostate.

Historically, a woman's vagina was removed along with the bladder in a radical cystectomy, making sexual intercourse impossible. Surgeons now are able in many cases to spare or repair the vagina.

If the bladder is removed, the surgeon will create another way to collect urine. You may have a pouch inside your body (continent reservoir or continent diversion) or wear a bag outside your body (ileal conduit or noncontinent diversion).

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Citations

1. Shipley WU, et al. (2005). Cancer of the bladder, ureter, and renal pelvis. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1168–1185. Philadelphia: Lippincott Williams and Wilkins.

2. National Cancer Institute (2006). Bladder Cancer PDQ: Treatment-Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional.

3. Jiminez VK, Marshall FF (2002). Surgery of bladder cancer. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 4, chap. 79, pp. 2819–2844. Philadelphia: W.B. Saunders.

4. Small EJ, Grossfeld GD (2003). Bladder. In M Dollinger et al., eds., Everyone's Guide to Cancer Therapy, 4th ed., pp. 401–411. Kansas City: Andrews McMeel.

Radiation therapy uses high-dose X-rays or other types of radiation to destroy bladder cancer cells. It may be used alone, before surgery to shrink the cancer, or after surgery to destroy any remaining cancer cells. Radiation therapy may also be used if a person with bladder cancer cannot have surgery.

External beam radiation comes from a machine outside the body. The machine aims radiation at the cancer area. Most people who receive external beam radiation therapy for bladder cancer are treated 5 days a week for 6 to 7 weeks as an outpatient.

Internal (interstitial) radiation therapy (brachytherapy) uses radioactive material contained in tiny tubes, wires, or beads. These are surgically placed in or near the tumor.

What To Expect After Treatment

Radiation therapy for bladder cancer often causes fatigue. You may also have problems with nausea, vomiting, diarrhea, or urinary discomfort. Home treatment and medication may help relieve these side effects.

Both men and women may have sexual problems following radiation therapy for bladder cancer. Women may experience vaginal dryness, and men may experience erection problems.

Why It Is Done

Radiation therapy destroys cancerous cells. It is commonly used with surgery to prevent bladder cancer from coming back (recurring). It is also a treatment choice if surgery is not recommended for another medical reason. Radiation can also be used to treat symptoms such as pain in advanced bladder cancer.

How Well It Works

Radiation therapy helps prevent recurrence of bladder cancer. It is more effective when it is used in combination with chemotherapy than when it is used alone.¹

Risks

Radiation therapy may cause a decrease in your white blood cells (leukopenia), which increases your risk of developing an infection. Your doctor will monitor your blood counts regularly and may change your treatment schedule until your white blood cell count returns to normal. You may also have side effects from radiation, such as:

• Nausea.
• Vomiting.
• Diarrhea.
• Pain or discomfort when urinating.
• Bladder inflammation and scarring (radiation cystitis).

Home treatment and medication may help relieve these side effects.

What To Think About

Radiation therapy can cause scar tissue in the treated area. If cancer progresses after radiation therapy, the scar tissue can make surgery more complicated.¹

External radiation may darken your skin color, and the change may be permanent. You may also lose your hair in the treated area, but usually it grows back.

Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.

Citations

1. Raghavan D (2003). Bladder, renal, and testicular cancer. In DC Dale, DD Federman, eds., Scientific American Medicine, section 12, chap. 14. New York: WebMD.

Note: Separate PDQ summaries on Bladder Cancer Treatment and Levels of Evidence for Cancer Screening and Prevention Studies are also available.

Benefits

There is inadequate evidence to determine whether screening for bladder and other urothelial cancers would have any impact on mortality.

Description of the Evidence

• STUDY DESIGN: There are no studies that directly address this question.
• INTERNAL VALIDITY: N/A.
• CONSISTENCY: N/A.
• MAGNITUDE OF EFFECTS ON HEALTH OUTCOMES: N/A.
• EXTERNAL VALIDITY: N/A.

Harms

Based on fair evidence, screening for bladder and other urothelial cancers would result in unnecessary diagnostic procedures with attendant morbidity.

Description of the Evidence

• STUDY DESIGN: Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.
• INTERNAL VALIDITY: N/A.
• CONSISTENCY: N/A.
• MAGNITUDE OF EFFECTS ON HEALTH OUTCOMES: Good evidence for rare harms.
• EXTERNAL VALIDITY: N/A.

Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor). General anesthesia or spinal anesthesia is usually used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.

Bladder cancer can come back after this surgery, so repeat TURs are sometimes needed.

What To Expect After Surgery

Following surgery, a catheter may be placed in the urethra to help stop bleeding and to prevent blockage of the urethra. When the bleeding has stopped, the catheter is removed. You may need to stay in the hospital 1 to 4 days.

You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 2 to 3 weeks following surgery.

You may be instructed to avoid strenuous activity for about 3 weeks following TUR.

Why It Is Done

TUR can be used to diagnose, stage, and treat bladder cancer.

• Diagnosis. TUR is used to examine the inside of the bladder to see whether there are cancer cells are in the bladder.
• Staging. TUR can determine whether cancers are growing into the bladder wall.
• Treatment. One or more small tumors can be removed from inside the bladder during TUR.

How Well It Works

TUR is the most common and effective treatment for early-stage superficial bladder cancer. It may also be effective for more advanced cancer if all the cancer is removed and biopsies show that no cancer cells remain.

About 70% of people with early-stage and low-grade superficial bladder cancer can be effectively treated with a TUR.¹

Risks

The risks of TUR include:

• Bleeding.
• Bladder infection (cystitis).
• Perforation of the wall of the bladder.
• Blood in the urine (hematuria).
• Blockage of the urethra by blood clots in the bladder.

What To Think About

Treatment with TUR may be followed by chemotherapy or biological therapy.

If superficial bladder cancer recurs, follow-up TURs may be done regularly.¹

About 30% of people with early-stage and high-grade superficial bladder cancer are treated with TUR, but additional chemotherapy or biological therapy may be recommended.¹

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Citations

1. Pashos CL, et al. (2002). Bladder cancer epidemiology, diagnosis, and management. Cancer Practice, 10(6): 311–322.