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Treatment Options and Candidacy

This section is dedicated to a broad overview of various options available for the treatment of bladder cancer.  Detailed descriptions and candidates most appropriate for these options will be found under each option title.

As with any health condition, it is not recommended that one make a treatment decision without advice from knowledgeable physicians.  It is important to consult with a physician with expertise in urological cancers about all treatment options for bladder cancer, including the risks and benefits.

Surgical Treatment Options for Bladder Cancer

Transurethral Resection of Bladder Tumor(TURBT): During this procedure, the surgeon inserts a thin lighted tube, called a cystoscope, through the urethra and into the bladder.  A tool with a small wire loop on the end, called a resectoscope, is then used to remove the cancer for biopsy and/or burn away the cancer cells with high-energy electricity.  This process is known as fulguration.

Candidacy: This procedure is most effective for tumor removal in patients who are experiencing early-stage bladder cancer.

Partial Cystectomy:

This bladder-preserving treatment involves surgical removal of the bladder tumor and surrounding bladder wall, but does not entirely remove the bladder.  This procedure is associated with the preservation of urinary bladder continence, though it can be associated with a higher local recurrence of bladder cancer.

Candidacy: This procedure is most effective in patients who have a normally functioning bladder with good capacity and a singular tumor located where a 1-2 cm resection margin is achievable.

Open Radical Cystectomy with Prostatectomy or Hysterectomy:

This procedure involves the removal of the bladder, pelvic lymph nodes and the prostate or the uterus.  Performed using traditional surgical techniques, this surgery can be done when the bladder cancer has invaded the muscle walls or when a superficial tumor involves a large portion of the bladder.  In men, the prostate and seminal vesicles are removed with the bladder as on specimen (en-bloc). In women, bladder removal includes the uterus, ovaries and/or part of the vagina.  If the cancer has spread to the outside of the bladder and cannot be completely removed, surgery to remove only the bladder is sometimes done to help alleviate urinary symptoms caused by the cancer itself.  If the bladder must be removed, the surgeon will create another way for urine to leave the body.

Candidacy: This procedure is most effective for tumor removal in patients who are experiencing advanced-stage bladder cancer.

Robotic-Assisted Laparoscopic Cystectomy with Prostatectomy or Hysterectomy:

This procedure involves the removal of the bladder, pelvic lymph nodes and the prostate or the uterus.  Performed using smaller incisions (than traditional open procedures) and the da Vinci robotic system to help the surgeon make the procedure more precise, this surgery can be done when the bladder cancer has invaded the muscle walls or when a superficial tumor involves a large portion of the bladder.  In men, the prostate and seminal vesicles are removed with the bladder as on specimen (en-bloc). In women, bladder removal includes the uterus, ovaries and/or part of the vagina.  If the cancer has spread to the outside of the bladder and cannot be completely removed, surgery to remove only the bladder is sometimes done to help alleviate urinary symptoms caused by the cancer itself.  If the bladder must be removed, the surgeon will create another way for urine to leave the body.

Candidacy: This procedure is most effective for tumor removal in patients who are experiencing advanced-stage bladder cancer.

Robotic Assisted Laparoscopic Bilateral Pelvic Lymph Node Dissection

This procedure involves the minimally-invasive complete of pelvic lymph nodes with the help of da Vinci robotic instrumentation to ensure precise removal.  It is typically performed at the time of a radical cystectomy or partial cystectomy and can be a diagnostic and therapeutic tool in both the detection of bladder cancer that has spread to the lymph nodes as well as the treatment of that cancer.

Candidacy: This procedure is most effective in the further diagnosis/treatment of that experiencing advanced-stage bladder cancer, or for those who have high-risk early stage bladder cancer and are heavily considering surgery to remove it.

Robotic Assisted Laparoscopic (or Open) Anterior Pelvic Exenteration:

This procedure, which can be performed in using open or minimally-invasive techniques, involves the removal of organs toward the front of the pelvic cavity that have been affected by bladder cancer including the bladder itself, urethra, anterior vagina, uterus and ovaries.

Candidacy: This procedure is most effective for tumor removal in patients who are experiencing advanced-stage bladder cancer.

Urinary Diversion:

During this procedure, the surgeon creates a new way for the body to store and pass urine if the bladder has been removed or needs to be bypassed.  Urology Cancer Specialists and Dr.  Ramin specialize in the following types of urinary diversion techniques;

  • Orthotopic Continent Ileal Neobladder: This type of diversion uses the patient's small intestine to create a new bladder ("neobladder"). The kidneys are attached to the new bladder, which stores urine just like a regular bladder.  The neobladder is then attached back to the urethra.  Once the neobladder is full, the patient will be able to empty his or her urine by voiding through the urethra.  The intention of creating this kind of diversion is to make it a continent system.  A continent system means that the neobladder will hold the urine without accidentally leaking.  Therefore, the neobladder intends to avoid the need for a patient to wear a bag for the rest of his or her life.

Candidacy: Most patients are good candidates for the first type of diversion listed above, continent neobladder.  However not all surgeons possess the skills to create a neobladder.  The neobladder is the most technically challenging type of diversion.  However it is the most natural kind of urinary diversion for the patient.  Dr.  Ramin routinely performs neobladders for men and women, as long as they are candidates.

  • Continent Cutaneous Diversion: Indian Pouch: This type of diversion uses the patient's small and large intestine to create a new bladder.  However the new bladder is not attached to the patient's urethra.  Instead, a small opening is created on the abdominal area, like a belly button.  This small opening leads to the urinary bladder storing the patient's urine.  The patient will insert a catheter through the opening into the bladder and allow the urine drain out of the body via the catheter.  The urine can be collected into a basin or into the toilet.  This system is continent, meaning the urine will not automatically drain out the opening.  It requires the patient to place the catheter every four to six hours.  Because it is continent, this type of system does not require patients to permanently wear a bag to collect the urine.
  • Ileal or Colonic Conduits: This type of diversion uses the patient's intestines to create a conduit for continuous passage of urine out of the body.  A stoma or a large opening is created on the abdominal wall, which allows the urine to drip out of the patient's body.  This system is not continent.  The urine does not collect into a pouch or bladder.  Every drop of urine that is made by the kidneys, drains automatically out the opening on the abdomen.  Therefore, this system requires the patient to wear a permanent bag.

Systemic Chemotherapy for Bladder Cancer

This type of cancer treatment uses powerful pharmaceuticals to slow down or halt the growth of bladder cancer cells, either by killing the cells directly or stopping them from dividing.  Typically, chemotherapy is administered to enter the bloodstream, thus reaching cancer cells throughout the entire body.

Candidacy: Systemic chemotherapy is usually used in patients with high stage bladder cancer.  It is used in patients with locally advanced cancer such as those with stage II or III cancer, as an adjunct to surgery in order to increase chance of cure.  It is also used in patients with stage four cancer as the primary modality of treatment.

Intravesical Immunotherapy or Chemotherapy for Bladder Cancer

Bladder cancer may also be treated with an intravesical approach.  In this approach medications are directly placed in the bladder that via a temporary tube inserted through the urethra.  These medications are either immune modulators or chemotherapy.  Immune modulators are medications such as the BCG or interferon.  When immune modulators are instilled into the bladder, they cause activation of the immune cells and inflammatory cells in the bladder.  These cells in turn kill the cancer cells.  Chemotherapy can also be directly placed in the bladder.  In this case the chemotherapy is intended to kill the cancer cells directly.

Candidacy: This procedure can be effective in patients with CIS (carcinoma in situ), high grade non-invasive cancers, or multifocal cancers.  It is not usually used in patients with muscle invasive cancers.

Radiation Therapy for Bladder Cancer

During this procedure, high-energy x-rays are used (and other types of radiation) to terminate cancer cells or to stop them from growing.

Candidacy: This procedure may be used in patients with bladder cancer, as an adjunct to surgery and/or chemotherapy.

Helpful Resources

National Cancer Institute at the National Institutes of Health — Kidney Cancer Home Page

da Vinci Surgery —Information about Kidney Cancer

AUA Foundation: The Official Foundation of the American Urological Association Kidney Cancer Facts

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