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Treatments for Advanced Stage Bladder Cancer
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When bladder biopsy reveals aggressive (high grade) or invasive (into bladder muscle) bladder cancer, more aggressive treatment is required. The standard treatment involves surgical removal of the bladder (termed cystectomy) and urinary diversion to restore urine drainage.
At Comprehensive Urology Medical Group, our aim is to provide our patients with excellent cancer control while maintaining their quality of life. Our surgeons, when clinically indicated, can perform cystectomy while preserving erectile function and urinary continence in men (prostate sparing cystectomy) and sexual function in women (vaginal wall sparing cystectomy in women). Our surgeons also are able to utilize the Da Vinci robot to perform robotic cystectomy. Other treatment options that can be used alone or along with surgery in specific cases include chemotherapy and radiation.
Surgical Options for Advanced Bladder Cancer
When bladder biopsy reveals aggressive (high grade) or invasive (into bladder muscle) bladder cancer, more aggressive treatment is required. The bladder may need to be removed in order to give the best chance for cure (termed cystectomy).
In men, traditionally the bladder, prostate and surrounding lymph nodes are removed. Most urologic surgeons only perform this type of cystectomy, and the end result is often urinary incontinence and almost always impotence.
At Comprehensive Urology Medical Group cancer control as well as overall quality of life of our patients is of utmost importance. Our surgeons can help determine before the surgery if you are a candidate for prostate sparing cystectomy. In certain cases, when the prostate and the nearby bladder is not involved with cancer, the prostate capsule can be spared in order to allow a continence and nerve sparing cystectomy. The allows the patient to keep his urinary control as well as preserve erectile function in a similar manner as nerve sparing radical prostatectomy.
In women , the bladder, uterus and lymph nodes are removed. In keeping with our goal to maintain quality of life while providing excellent cancer treatment, in many women, depending on the stage of disease, our surgeons can preserve the vagina and sexual function as well.
Most surgeries are performed using an open surgical incision in the lower abdomen. Certain patients may be candidates for the robotic surgical approach. Using this approach, the cystectomy is performed by using the robotic instruments through small keyhole incisions. A small incision is then used to perform the urinary reconstruction to restore urinary drainage.
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Robotic Surgery for Bladder Cancer (Da Vinci Cystectomy)
The surgery, also termed robot assisted radical cystectomy, is performed by a surgeon utilizing the Da Vinci robot to enhance minimally invasive surgical techniques in a similar manner in which it is used for prostate cancer.
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Bladder Reconstruction Surgery
When the bladder is removed for aggressive and invasive bladder cancer, a urinary diversion needs to be performed in order to restore normal urinary drainage. There are different types of diversion that may be performed depending on each patient. These include:
Ileal conduit: our surgeons use a small segment of the small intestine (termed the “ileum”) and attach the ureters to one end of the segment. The other end is connected to the lower abdominal wall to allow urine to exit into a small drainage bag (termed a urostomy) through a nickel size opening. It is considered the least complicated of urinary diversions
Neobladder: our surgeons use a longer segment of the intestine to make a new bladder (“neo-bladder”). The intestine is reconstructed into a spherical shape resembling the normal bladder. This is then connected to the urethra to allow patients to urinate more naturally and not need any external devices such as a “bag”. When used with prostate sparing cystectomy, this can provide the patient with a new bladder and complete urinary control while preserving erectile function.
Continent reservoir: For eligible patients who cannot have the neo-bladder connected to their urethra (ie. invasive cancer into the pelvis, previous extensive pelvic irradiation), but prefer not to have an external “bag”, our surgeons use the intestine to create a new bladder (neo-bladder) and create a continence mechanism for it. It is the connected to the abdominal wall. Patients then drain the pouch every several hours with a catheter, so no permanent external drainage bag is used.
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Other Treatments for Advanced Bladder Cancer
Chemotherapy: Chemotherapy can be utilized in multiple ways for the treatment of bladder cancer. When a patient has a cancer that is highly aggressive, chemotherapy can is sometimes used in conjunction with surgery (either before or after surgery) to help decrease the chance of spread (metastasis).
Chemotherapy also is used to treat metastatic bladder cancer (cancer that has spread to other organs).
Radiation Therapy: Although surgery and chemotherapy are considered the main treatment for advanced bladder cancer, simultaneous chemotherapy and radiation can be used as an alternative to try to save the bladder (bladder sparing therapy). This type of treatment is only about 40% effective in controlling bladder cancer.
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