The bladder is an essential organ that stores and eliminates toxins and waste from the body. Bladder cancer begins in the cells of the bladder. Transitional cell carcinoma, starting in the bladder's inner lining cells, is the most common type of bladder cancer, whereas squamous cell carcinoma and adenocarcinoma is less common.

Different treatment options for bladder cancer include surgery, chemotherapy, and immunotherapy, depending on individual factors such as cancer stage and overall health. Alone or a combination of surgical interventions such as Transurethral Resection of Bladder Tumour (TURBT), radical cystectomy, partial cystectomy, chemotherapy, and immunotherapy may be tailored to address the unique needs of a cancer patient. Early detection and a customised treatment plan are crucial for favourable outcomes in bladder cancer management.

This article focuses on bladder cancer surgery options based on the type and stage of cancer and the overall health of the patient. You will also get insights into the procedures involved, the recovery process, and potential side effects that will be there with surgery, making the patients empowered to make informed decisions regarding their treatment journey.

Types of Treatment for Bladder Cancer

The foremost treatment for bladder cancer is surgery. The type of surgery depends on the invasiveness and location of the cancer. The doctors might recommend other treatments in addition to surgery. The following are some procedures involved with bladder cancer:

Transurethral Resection of Bladder Tumour (TURBT)

It is a minimally invasive procedure performed using a cystoscope inserted through the urethra into the bladder. This type of surgery is used for diagnosing and removing early-stage bladder tumours that have not spread in the bladder wall, leaving the bladder intact.

Cystectomy

A cystectomy is a surgical procedure that removes all or part of your bladder. There are two options or two types of cystectomy:

Radical cystectomy - In radical cystectomy, the whole bladder and the nearby tissues and organs get removed. For men, these organs include the prostate and part of the urethra. And for women, it includes the uterus, fallopian tubes, ovaries, and part of the vagina.
Partial cystectomy - Partial cystectomy is surgery to remove part of the bladder. It is an optimal option for patients with a low-grade tumour that has invaded the wall of the bladder but is limited to one area of the bladder.

Neobladder reconstruction

In this procedure, the doctors surgically construct a new bladder using a piece of the intestine. This new bladder allows a person to urinate voluntarily and control when to urinate.

Urostomy

Urostomy, also known as an ileal conduit, is another procedure for creating a urinary diversion. In this, the doctors create a small opening in the abdominal wall and divert the urine to this opening, known as a stoma or ostomy, on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

Procedure Details

Each treatment option has a specific process to follow. Below are the details for each treatment's procedure:

Transurethral Resection of Bladder Tumour (TURBT)

TURBT is typically performed under general anaesthesia using a cystoscope. It is a thin tube with a light and camera inserted through the urethra into the bladder.
With the help of the camera, the surgeon sees and identifies any abnormal tissue or tumours inside the bladder.
Special instruments passed through the cystoscope help to remove the tumour tissue under the guidance of the visuals provided by the camera.

Radical Cystectomy

Radical cystectomy is a major surgical procedure performed under general anaesthesia.
In this process, the surgeon makes an incision in the lower abdomen or pelvic area to access the bladder.
The entire bladder is carefully dissected and removed, along with surrounding lymph nodes if necessary.
The surgeon may remove the prostate and seminal vesicles in men. For women, they may remove the uterus, fallopian tubes, ovaries, and part of the vagina might be removed with the bladder, depending on the extent of the cancer.

Partial Cystectomy

As the name says, in partial cystectomy, only a portion of the bladder containing the cancerous tissue is removed, preserving the remaining healthy bladder tissue.
This procedure is performed using open surgery or minimally invasive techniques.
The surgeon carefully identifies and removes the tumour with a margin of healthy tissue to ensure complete removal.
Reconstructing the bladder might be needed, depending on the size and location of the tumour.

Procedure for Urinary Diversion

After the cystectomy (in both radical and partial cystectomy), the surgeon creates a new way for urine to exit the body, such as through a urinary diversion procedure. There are two major ways a urinary diversion procedure can be done:

Neobladder Reconstruction

In neobladder reconstruction using a segment of the intestine, a new bladder is constructed.
The surgeon creates a pouch-like structure resembling a bladder and attaches it to the ureters and urethra to allow for voluntary urination.
Patients undergo training to learn how to control urination using their new neobladder.

Urostomy (Ileal Conduit)

In urostomy, a small segment of the intestine is used to create a conduit for urine.
One end of the conduit is attached to the ureters, while the other is brought through the abdominal wall to create a stoma.
A pouch or bag is attached to the stoma outside the body to collect and drain urine.

Recovery process

The determinant factor in post-surgery recovery is the overall health and fitness of the patient. Besides that, it also depends on the type of surgery performed and the extent of the procedure. A general overview of how the process of recovery takes place for bladder cancer surgery is as follows:

Immediately after surgery, the patients are put in postoperative care in the hospital to closely monitor their vital signs to ensure stability and watch for any post-surgery complications.
Medications are given to manage pain and alleviate discomfort.
Intravenous lines are inserted in the patient to keep them hydrated and administer the medications for the patient to recover enough to be able to sit and consume meals or stay hydrated.
Tubes are also put in place to drain urine from the surgical site.
The hospital stay duration varies on the intensity of the surgery or procedure performed. Patients undergoing minimally invasive procedures such as TURBT might have a shorter stay as compared to a procedure such as radical cystectomy, where the whole bladder is removed.
A patient needs special care and rest to recover for 6-8 weeks.

Potential Side effects

Just like any other surgery, bladder cancer surgery can also have some potential side effects and complications. Some of them are listed below:

Specific Side Effects of Radical Cystectomy

Radical cystectomy involves urinary diversion as neobladder reconstruction or urostomy. There could be a significant chance of urinary leakage, infection or difficulty in adjusting to the new method of urination. In addition to the bladder, other parts, like the prostate in men and the uterus in females, are also removed, causing some sexual dysfunction.

Specific Side Effects of Partial Cystectomy or TURBT

Bladder irritation, frequent urination, urgency, or burning with urination are some of the common side effects post a partial cystectomy or TURBT. If not all cancerous tissues are extracted or if the cancer is invasive, there is a risk of recurrence.

It is vital to discuss all the potential side effects and complications with your doctor or healthcare team before undergoing bladder cancer surgery. Close monitoring and follow-up care help manage these side effects and optimise the long-term outcomes of the surgery.

Conclusion

Fighting bladder cancer involves understanding the available surgical options and preparing both physically and emotionally for the journey ahead. It is a long journey from diagnostic tests to doing consultations with medical teams to mentally preparing to ensure a smooth process. With proper care, regular follow-up, and monitoring for recurrence, you can increase the outcome and make it easier for long-term management. With the correct information, you make informed decisions and navigate the complexities of bladder cancer surgery.

FAQs About bladder cancer

Q1. What are the treatment options for bladder cancer?
A1. The treatment options for bladder cancer include surgeries (TURBT, radical cystectomy, or partial cystectomy), chemotherapy, and immunotherapy.

Q2. How is bladder cancer diagnosed?
A2. Bladder cancer is diagnosed through urine tests, imaging studies (like ultrasound or CT scans), and cystoscopy, which involves using a camera to examine the bladder. Biopsy samples may be taken during cystoscopy to confirm cancer cells.

Q3. What is Neobladder?
A3. A surgically created bladder made from a portion of the intestine for urinary diversion is called a neobladder.

Q4. What does a mass on the bladder mean?
A4. A mass on the bladder is an indicative or presence of abnormal tissue growth. It may be benign or malignant. If an abnormal tissue growth is detected, it may warrant further investigation, such as imaging tests and biopsies.

References:

https://www.hopkinsmedicine.org/greenberg-bladder-cancer-institute/bladder-cancer-treatment/before-after-surgery
https://www.cancercenter.com/cancer-types/bladder-cancer/treatments/cystectomy
https://www.cancer.gov/types/bladder/treatment
https://www.cancer.net/cancer-types/bladder-cancer/types-treatment