Treatment for bladder cancer varies greatly depending on the stage of the disease at the time of diagnosis. At Vanderbilt, a team of surgeons, medical oncologists, and pathologists – all of whom specialize in the diagnosis and treatment of bladder and other genitourinary cancers – work together to make recommendations that are personalized to each individual patient.
In superficial bladder cancer, primary treatment is usually minimally invasive surgery using cystoscopes and using laser or electrical energy. As a precaution, patients at high risk of cancer recurrence or metastasis also may receive therapies that are instilled within the bladder. Examples of these medications include mitomycin C and BCG (Bacillus Calmette and Guerin) therapy. The therapy is placed directly into the bladder through a catheter that is gently passed through the urethra. The treatment schedule varies, as does the duration. Specific complications and possible side effects will be discussed with you by your treating physician. Guidelines for the treatment of noninvasive bladder cancer were recently published and are available on the American Urological Association web site.
Invasive bladder cancer is cancer that has spread into or beyond the muscle layer of the bladder wall. Surgery to remove the bladder is the most common treatment for invasive bladder cancer, although radiation and/or chemotherapy can play a role. Chemotherapy may be initiated prior to surgery to attempt to eradicate cancer that may be outside the bladder.
For patients whose tumors require surgery to remove the entire bladder, it is almost always necessary to remove the surrounding lymph nodes and organs (e.g., the prostate and seminal vesicles in males and uterus, fallopian tubes, and ovaries in females) to help prevent cancer recurrence or metastasis. Following bladder removal, surgeons must create a new way for the body to store urine and empty urine. One approach, called an ileal conduit, requires a patient to wear a bag on the outside of the body to collect urine. During this procedure, a conduit for the urine is created using a segment of the small intestine. It transfers urine directly from the kidneys and ureters through a stoma on the skin and into the collection bag.
Surgeons at Vanderbilt, however, have been among the country’s pioneers in a more advanced technique of urine drainage that eliminates any type of continuous external collection bag. I n forming a “neobladder,” Vanderbilt surgeons configure a length of intestine that simulates a bladder and then a “hook-up” is accomplished with the patient’s urethra so that the individual can void urine like he or she did prior to the radical cystectomy. At Vanderbilt, our surgeons have performed hundreds of the neobladder procedures.
With our emphasis on minimally invasive surgery techniques, the Vanderbilt surgeons have been the first and continue to be the only surgeons in the state performing radical cystectomy (entire bladder removal) with the DaVinci™ robot to decrease postoperative pain and significantly speed up recovery. The surgical volume for this procedure is higher than anywhere in the Southeastern portion of the United States.
Metastatic bladder cancer usually spreads to the lung, liver, or bones. It is most commonly treated by chemotherapy to shrink tumors. As a front-line treatment for metastatic bladder cancer, Vanderbilt Oncologists under the direction of Dr. Bruce Roth, are using various combinations of chemotherapy drugs including paclitaxel (Taxol), gemcitabine (Gemzar), ifosfamide (Ifex), cisplatinum and carboplatinum with encouraging results.