Surgical Procedures for Bladder Cancer
Surgery is a common treatment for bladder cancer. The goal is to remove the tumor(s) and preserve as much bladder function as possible. The type of surgery depends on the stage of the cancer. The impact on bladder function depends on the stage, the type of surgery needed, and overall health.
Surgery for Early Stage Bladder Cancer
This type of surgery is often used to treat forms of bladder cancer that have not invaded the muscle tissue. A transurethral resection (TUR) is done with a cystoscope. During cystoscopy
, a tube is passed through the urethra and into the bladder. The scope allows the doctor to see inside the bladder and pass instruments through the tube. The tumor is removed with a wire loop, chemicals, or by laser. Tissue samples will also be taken so they can be examined under a microscope.
TUR can cure cancer in those with very superficial, early stage bladder cancer. For others, it may be used in combination with
It is not unusual for bladder cancer to return even if all the tumors are removed. This procedure may need to be repeated multiple times.
If the cancer has spread beyond superficial surfaces of the bladder and into the muscle, a cystectomy may be needed. A cystectomy is the removal of part or all of the bladder. Early stage bladder cancer may only require a partial cystectomy which can leave a smaller but still functioning bladder.
This surgery removes tissue of the bladder through an incision in the abdomen. The doctor may also take out nearby lymph nodes to see if cancer has spread.
Surgery for Advanced Bladder Cancer
A radical cystectomy may be needed for more advanced cancers. A radical cystectomy involves removing the tumor, the entire bladder, and surrounding lymph nodes. In men, the prostate gland is also removed. In women, the ovaries, fallopian tubes, the uterus, and a small portion of the vagina are often also removed
along with the bladder. Cystectomy may provide a cure for some types of bladder cancer, but some may need additional therapies such as chemotherapy.
Since the bladder is removed, there is no way to store or eliminate urine from the body. A urinary diversion will be created to allow the urine to leave the body. Options include:
Conduit diversion—The ureter will be connected to a section of the small intestine so that the urine can drain into the intestine. The intestine is then connected to an opening in the abdominal wall called the stoma. Waste (including urine) can pass through the stoma and into a collection bag outside of the body.
Continent diversion—The ureters are connected to a pouch made from the small and large intestines. The intestine is then connected to a stoma. Waste (including urine) can pass through the stoma and into a collection bag outside of the body.
Neo-bladder—This method preserves as much bladder function as possible. A pouch is created using intestinal tissue. Both the ureters and urethra are connected to this pouch so that urine can pass out of the body as it normally would. A catheter may be needed to help the urine pass out of the body. This type of urinary diversion can also be done if the cancer is blocking urine flow and a cystectomy is not an option.
Bladder cancer. American Cancer Society website. Available at:
http://www.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf. Accessed June 29, 2015.
Bladder cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115106/Bladder-cancer. Updated May 6, 2016. Accessed October 6, 2016.
Cystectomy. Encyclopedia of Surgery website. Available at: http://www.surgeryencyclopedia.com/Ce-Fi/Cystectomy.html. Accessed June 29, 2015.