Your Chesapeake Urology bladder cancer specialist will develop a personalized and comprehensive treatment plan that best meets your individual needs and will review this plan with you so that you are comfortable with the next steps. Determining the appropriate treatment depends on a number of factors, including your health and age, tumor histology, tumor grade, and tumor stage.
Potential treatments for bladder cancer include:
- Immunotherapy – Bacillus Calmette-Guérin (BCG), which is a live but disabled bacteria, is instilled into the bladder initially once weekly for six weeks, and in some cases, at three to six month intervals for up to three years. Your urologist will remove any tumor from the bladder wall before BCG is administered. BCG is used to trigger the body’s immune response against the cancer cells. It is used to lower the risk of cancer from recurring.
- Chemotherapy – Various chemotherapeutic agents can be instilled into your bladder in an attempt to prevent future recurrences of your tumor.
Chesapeake Urology’s bladder cancer specialists are among the regions’ leading surgeons. Our bladder cancer specialists include fellowship trained urologic oncologists who utilize the most advanced surgical and reconstructive techniques to provide you with the best results possible.
- TURBT (transurethral resection of bladder tumor) – This is an endoscopic surgery performed to remove a bladder tumor. A surgical telescope is passed via the urethra into the bladder and an electrosurgical loop is used to remove the tumor and fulgurate the base. This procedure is not only therapeutic in removing all visible tumor, but it is also diagnostic in that it allows the physician to collect tissue for a pathologist to evaluate the histology, grade, and stage of the tumor.
- Radical Cystectomy – This technique involves the total removal of the bladder. The procedure usually also involves removal of lymph nodes and other sexual organs (the prostate and seminal vesicles in men; the uterus, fallopian tubes, ovaries, and part of the vagina in women). Radical surgical treatment is often recommended for patients with invasive bladder cancer, in select patients with high-risk, non-invasive cancer and when other non-surgical therapies have not been successful.
A radical cystectomy can be performed as a traditional open surgery or robotically. Based on your health history and type of bladder cancer, your surgeon will determine if you are an appropriate candidate for a robotic cystectomy.
- Urinary Diversion – For patients who receive a radical cystectomy, your surgeon will perform a procedure called a urinary diversion, which provides your body with a way to potentially store and remove urine in the absence of your bladder.
There are several types of urinary diversion:
- Ileal Conduit (ileal loop) – This is the most common and simplest type of urinary diversion. A segment of the intestine (ileum) is used to create a pipe or pathway, connecting the ureters to the outside of the body through an opening in the abdominal wall. The opening is called a stoma, and is covered with a bag that collects urine as it drains from the ileal conduit. This diversion is the easiest for many patients and has no physical limitations, although some patients find that the bag interferes with self-image.
- Continent (catheterizable) Reservoir – In this procedure, an internal pouch is created from a portion of the intestines and the ureters are repositioned to drain into this pouch. A stoma is created using a piece of the intestine, and brought out throughan opening in the navel. Unlike the ileal conduit, no bag is used. A one-way valve is created to keep the urine inside of the pouch. Then, a catheter must be inserted into the stoma every four to six hours to drain urine from the pouch.
- Neobladder (new bladder) – A segment of the intestine is harvested and used to create a new “bladder.” Your surgeon will reconfigure a segment of bowel into a spherical pouch and attach the pouch to the urethra. Urine is able to drain from the kidneys, to the ureters, to the pouch and through the urethra in a way that is similar to the normal passing of urine.
With the neobladder, patients do not have to wear an appliance or bag and do not have a dramatic change in body image, although incontinence, particularly at night, is one of the disadvantages. This surgery is more complex and patients have to “re-learn” how to urinate. In addition, many patients have to catheterize the neobladder via the urethra. With any surgical procedure, there are advantages as well as risks and complications that may arise. Your urologist will discuss your surgical options in detail with you to help you make the most informed decision.
Chemotherapy is an important tool in the treatment of advanced bladder cancer, or bladder cancer that has spread to other areas of the body. Usually, a combination of chemotherapy drugs is used to kill the cancer cells, through injection into a vein (intravenous). Chemotherapy can be administered before and/or after surgery and can be used in combination with radiation.
Radiation therapy can sometimes be used in combination with intravenous chemotherapy (trimodality therapy) in patients with invasive cancer in an effort to save the bladder. In this case, your urologist will perform a transurethral resection (TUR) of the bladder tumor and a medical oncologist and radiation oncologist will administer a combination of chemotherapy and radiation therapy respectively.
Learn about bladder cancer prevention.