Bladder Cancer Surgery

Non-muscle invasive bladder cancer

These cancers rarely spread and can usually be cured. Left untreated they may, in some cases, develop into muscle-invasive tumours.

These are usually treated in the following ways :

• Transurethral resection of bladder tumour (TURBT). Under anaesthesia, an instrument called a resectoscope is inserted through the penis. The surgeon uses the resectoscope to remove the tumour tissue one piece at a time using a special wire loop. The pieces of tissue are flushed out at the end of the operation.
• Intravesical therapy. After resection, chemotherapy agents such as mitomycin or immunotherapy such as BCG (Bacille Calmette Guerin) therapy may be given through a catheter into the bladder to reduce the risk of recurrence and disease progression. Immunotherapy uses substances made by the body or in a laboratory to boost, direct, or restore the body’s natural defenses against cancer.

Muscle-invasive bladder cancer

Muscle-invasive tumours have a high chance of spreading to other parts of the body and treatment is usually more aggressive.

Treatment options may include :

• Surgery. Surgery involves removal of the entire bladder (radical cystectomy). Under general anaesthesia, the surgeon removes the entire urinary bladder and the surrounding lymph nodes in the pelvis. The prostate is removed in the male and the uterus, ovaries, fallopian tubes and part of the vagina are removed in the female.
• Radiation therapy. Radiation therapy is a cancer treatment that uses high-energy x-rays to kill cancer cells or keep them from growing.
• Chemotherapy. Chemotherapy is the treatment of cancer by using anti-cancer drugs that kill cancer cells, or stops them from multiplying. It may be given before or after surgery. Patients may experience nausea, hair loss (alopecia), inflamed cheeks, gums, tongue, lips, and roof or floor of the mouth (stomatitis), and abnormal blood profile that increases the risk of infection.

Sometimes a combination of treatment with chemotherapy with surgery or radiation is needed to improve the chances of cure in selected patients.

Treatment under clinical trial

Photodynamic therapy (PDT) is a cancer treatment in which a lightsensitive drug is administered to the bladder and laser light is used to activate the drug to kill the cancer cells.

What happens during surgery?

At the time of surgery, the entire bladder is removed. The ureters are disconnected from the bladder and joined to a loop of small intestines specially fashioned to contain urine.

Depending on the pre-operative medical condition, stage of disease, and ability to perform clean intermittent self-catheterisation, the loop of small intestine may be :

1. Connected directly to the abdominal wall and urine flows out through a urinary stoma (ileal conduit).
2. Fashioned into a sphere (ileal neobladder) and reattached to the urethra. Urine passes out through the normal passage. Some patients may need to catheterise their urine passage regularly everyday to empty the bladder, as the neobladder does not have the sensory and contractile properties of the native bladder.