Bladder Cancer Surgery & Surgical Procedures
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Surgery for Bladder Cancer
Surgery is typically the first treatment option for early-stage bladder cancers because tumors have likely not spread to other areas of the body.
At Cancer Treatment Centers of America (CTCA), we may perform surgery for bladder cancers that have recurred or metastasized. For some patients, a bladder-preserving approach may be the best option. For others, removal of the entire bladder may reduce the risk of a subsequent cancer. Your doctor will discuss all of your treatment options, so that you can make the best decision for your care. Our surgical oncology experts are experienced in a variety of procedures and we proactively manage the side effects of bladder cancer surgery.
Depending on the stage of the disease, your doctor may recommend one or more of the following bladder cancer surgical procedures.
- Transurethral Resection: This procedure, also called “transurethral resection of the bladder tumor,” is common for early-stage bladder cancers, or those confined to the superficial layer of the bladder wall. This bladder cancer surgery is performed by passing an instrument through the urethra, which avoids cutting through the abdomen. The surgical instrument used for this operation is called a resectoscope. A wire loop at one end of the resectoscope is used to remove abnormal tissues or tumors.
After this procedure, burning the base of the tumor (fulguration) can help ensure that any remaining cancer cells are destroyed. Alternatively, a high-energy laser may be used. With either approach, a cytoscope is used to view the inside of the bladder during the procedure.
- Cystectomy: This bladder cancer surgical procedure may be used to remove either the entire bladder or portions of it. Sometimes, the bladder may be accessed through an incision in the abdomen. It may also be possible to do laparoscopic surgery. With this approach, several small incisions are made using long, thin instruments, one with a video camera on the end that enables the surgeon to see inside the pelvis. Laparoscopic surgery, also called keyhole surgery, may reduce pain and shorten recovery time. However, because this type of surgery for bladder cancer is newer, there is less evidence of its long-term benefit in treating bladder cancer.
- There are two types of cystectomies:
- Partial Cystectomy: If cancer has invaded the muscle layer of the bladder wall, but is not large and is confined to one region of the bladder, then it may be possible to treat the cancer by removing only part of the bladder. With this procedure, the portion of the bladder where there is cancer is removed, and the hole in the bladder wall is then closed.
- Radical Cystectomy: If cancer is larger in size or is in more than one region of the bladder, then the entire bladder may need to be removed. With a radical cystectomy, nearby lymph nodes may also be removed, along with the prostate (for men), and, for women, the ovaries, fallopian tubes, uterus and a small part of the vagina. This type of bladder cancer surgery is an extensive procedure, but may help ensure that all cancer cells are removed from the body and reduce the likelihood of the disease recurring.
- Reconstructive Surgery: If the entire bladder is removed with a radical cystectomy, then an alternative pathway in the body is needed for urination. Creating this new route is part of reconstructive surgery. There are several ways for urine to be removed from the body when the bladder has been removed.
One approach our surgical oncology teams may use is to remove a small piece of intestine and connect it to the ureters, creating a passageway (called an “ileal conduit”) for urine to pass from the kidneys to the outside of the body. An opening, or stoma (also called “urostomy”), is made on the front of the abdomen, and the conduit is connected to this hole.
Another way to remove urine is with a “continent diversion.” Here, a pouch is made from a piece of intestine, and a valve is created in the pouch. Urine is stored in the pouch. Several times each day, the pouch is emptied putting a drainage tube (catheter) into the stoma through the valve. With this approach, there is no bag on the outside of the body.
A third, newer approach allows our surgical oncology teams to restore urination back into the urethra. In this procedure, a piece of intestine is used to create a place where urine can be stored. The ureters are connected to this “neobladder.” The difference between this approach and the others is that the neobladder is sewn to the urethra, which allows for normal urination.
Another type of reconstructive surgery may be done when bladder cancer is in an advanced stage and cannot be removed by surgery. With this approach, urine is diverted away from the bladder, even though the bladder is not removed. This procedure can help prevent or treat any blockage of urine flow.
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