Treatment options for bladder cancer depend on a number of factors, including the type, stage, and aggressiveness of the cancer, as well as the overall health of the patient.
For early stage bladder cancer, treatment options include:
- A transurethral resection of bladder tumor (TURBT), which is a standard surgical procedure for non-muscle invasive bladder cancer, both to diagnose and remove cancerous tissue. During surgery, a cystoscope (endoscope) is directed into the bladder through the urethra. A resectoscope is then used to remove the tumor, as well as burn away any remaining cancer cells.
- For some patients, the doctor may also recommend the use of cancer-killing drugs to reduce the chances of recurrence. The procedure involves the anti-cancer drug solution being administered through a catheter, which is inserted through the urethra into the bladder. The catheter is then removed and the patient is required to hold the fluid in the bladder for about 2 hours before releasing it through urination. This treatment is carried out on a weekly basis for at least 6 consecutive weeks.
In cases where the cancer has invaded the layers of the bladder wall, or has reached stage 2 or higher, the doctor may consider surgery to remove the entire bladder (combined with chemotherapy and/or radiation therapy) to reduce the chances of spread and recurrence of the cancer.
In a radical cystectomy, the entire bladder is removed, as well as its surrounding lymph nodes and other structures adjacent to the bladder that may contain cancer. In men, a radical cystectomy typically includes removal of the prostate and seminal vesicles which are behind the bladder and adjacent to the prostate. In women, it involves removal of the uterus, fallopian tube, ovaries, and part of the vagina.
If the entire bladder is completely removed, a new urinary tract must be constructed for urine to exit the body. Options include:
- Ileal Conduit Urinary Diversion – A segment of the distal small intestine, the ileal, is used for the diversion of urine, which drains freely from the ureters. The proximal end of the segment is closed, and urine drains through the stoma (the distal end of the segment with an opening in the abdominal wall) to a bag that collects urine that is worn on the outside of the body.
- Continent Urinary Diversion (Indiana Pouch) – A part of the patient’s intestine is used to create a reservoir inside the body to collect urine. A catheter is used to empty urine through the stoma throughout the day.
- Orthotopic Continent Urinary Diversion (Neobladder) – A part of the patient’s intestine is used to create a reservoir inside the body to collect urine, which is then connected to the urethra, allowing for normal urination.