City of Hope brings together highly skilled and advanced resources to manage the treatment of patients with bladder cancer. Our multidisciplinary team includes urologists, medical oncologists, radiation oncologists and surgical oncologists working cooperatively to create the most effective treatment plan possible.
Surgery to remove cancerous tissue is a primary treatment at all stages of bladder cancer. Different procedures may be chosen based on the individual patient’s diagnosis. City of Hope surgeons are among the most experienced in the country and have excellent success rates using a range of advanced technologies.
Whenever possible, our bladder cancer patients are treated with minimally invasive techniques. These include laparoscopic surgery, performed using thin, flexible instruments that are inserted through small “keyhole” incisions.
City of Hope is also a leader in applying the robotic-assisted da Vinci S Surgical System. Controlled by an experienced surgeon, the system combines extremely precise movements with three-dimensional imaging to achieve excellent surgical results.
Potential benefits of minimally invasive surgeries include:
- Less blood loss, pain and visible incisions
- Shorter hospital stays and recovery time
- Fewer post-operative complications
- Quicker return to normal activities
The most effective surgical procedures depend on a cancer’s stage, including how large it is, and whether it has spread to other tissues. Treatments include:
- This surgery (sometimes called a polypectomy) is used to remove precancerous polyps and very small cancers.
- This minimally invasive surgical procedure, performed through the urethra, is most useful for removing those cancers that have not advanced beyond the lining of the bladder. In most low-grade, low-stage tumors, resection is all that is required.
- In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor often chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.
- For invasive bladder cancer, the most common type of surgery is radical cystectomy. The doctor may also choose this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes and part of the vagina are removed.
- Many patients today who require the removal of the entire bladder are candidates for continent urinary diversion, a type of surgery that involves complete pelvic reconstruction that allows patients to recover normal urinary function.
Robotic cystoprostatectomy, a novel urinary bladder reconstructive procedure, has shown success in reducing blood loss and speeding recovery. Bladder cancer patients can resume normal physical activity and bladder control perhaps more quickly than ever.
City of Hope is one of the few institutions in the world performing minimally invasive robotic surgery on a routine basis. In this operation, we have demonstrated that the same cancer curing operation can take place in removing the entire bladder and equivalent pelvic lymph nodes, as would be removed in transabdominal radical cystoprostatectomy. To perform the surgery, five or six small incisions (ports) are used, just as in laparoscopic radical prostatectomy.
After the bladder and the lymph nodes are completely contained, the specimen is removed after being placed in a bag through a small incision (five to six cm) extending just below and above the umbilicus (navel). The surgeon then constructs a new bladder out of the patient’s own intestine that will transport the urine externally, taking the place of the patient’s urinary bladder.
In patients that are candidates for pelvic reconstruction, the new bladder can be reconnected to the urethra. After the healing phase, those patients can urinate naturally (see urinary reconstruction). This portion of the operation is done completely laparoscopically and with greater precision.
Early results of this procedure indicate that blood loss is greatly reduced, and the overall physical recovery is far quicker – patients have a quicker return to normal physical activity and normal bladder control.Radiation is a form of energy that has long been used to treat many kinds of cancers. In bladder cancer, radiation may be given to relieve pain, in combination with chemotherapy, or after surgery to minimize the risk of recurrence. Treatments in which beams of energy are directed at the tumor from an outside source are referred to as external beam radiation.
At City of Hope, external beam radiation treatments may include:
Considered the most advanced radiation therapy available, helical TomoTherapy allows doctors to target and destroy cancer cells very precisely while sparing healthy tissues nearby. City of Hope was the first in the western U.S. to provide treatment for bladder cancer using this therapy.
Chemotherapy refers to drugs that are given to treat cancer. These medicines are administered either intravenously or orally. Chemotherapy may be combined with other treatments, and are often used to combat cancer that has spread beyond the bladder.
Patients who have a rapid recurrence of superficial bladder cancer often receive treatment known as intravesicular chemotherapy. Intravesicular procedures, which involve delivering anticancer agents directly into the bladder via a catheter, have the advantage of confining the anticancer agents to the bladder, maximizing exposure to tumor cells while minimizing exposure to the remainder of the body. Most of these patients will be recommended to receive intravesicular treatment with BCG (Bacillus Calmette-Guérin).
BCG is an attenuated (changed) live tuberculosis organism that has been altered so it will not cause tuberculosis. BCG works by enhancing the body’s own immune system so it can better kill the cancer cells.
Erectile dysfunction and loss of bladder control are potential — most often temporary — side effects of prostate gland removal. At City of Hope, patients report a 70 percent continence rate six months after surgery. Regaining sexual potency depends on the extent of your surgery, and how functional you were before the operation. Most men find that their erections return a week to 18 months after their surgery. Medications may be used to assist with recovery.
Many men find City of Hope’s Prostate Support Group helpful, as well as our Continence Recovery Program and assistance for potency recovery.