BLADDER CANCER SURGERY OPTIONS

Surgery is typically the first treatment option for early-stage bladder cancers because tumors have likely not spread to other areas of the body.

We may perform surgery for bladder cancers that have recurred or metastasized.  For some patients, a bladder-preserving approach may be the best option.  For others, removal of the entire bladder may reduce the risk of a subsequent cancer. Your doctor will discuss all of your treatment options, so that you can make the best decision for your care.  Our surgical oncology experts are experienced in a variety of procedures and we proactively manage the side effects of bladder cancer surgery.

Depending on the stage of the disease, your doctor may recommend one or more of the following bladder cancer surgical procedures.

Transurethral resection: This procedure, also called “transurethral resection of the bladder tumor,” is common for early-stage bladder cancers, or those confined to the superficial layer of the bladder wall.  This bladder cancer surgery is performed by passing an instrument through the urethra, which avoids cutting through the abdomen.  The surgical instrument used for this operation is called a resectoscope.  A wire loop at one end of the resectoscope is used to remove abnormal tissues or tumors.

After this procedure, burning the base of the tumor (fulguration) can help ensure that any remaining cancer cells are destroyed. Alternatively, a high-energy laser may be used. With either approach, a cytoscope is used to view the inside of the bladder during the procedure.

Cystectomy: This bladder cancer surgical procedure may be used to remove either the entire bladder or portions of it. Sometimes, the bladder may be accessed through an incision in the abdomen. It may also be possible to do laparoscopic surgery. With this approach, several small incisions are made using long, thin instruments, one with a video camera on the end that enables the surgeon to see inside the pelvis.  Laparoscopic surgery, also called keyhole surgery, may reduce pain and shorten recovery time.

There are two types of cystectomies:

Partial cystectomy: If cancer has invaded the muscle layer of the bladder wall, but is not large and is confined to one region of the bladder, then it may be possible to treat the cancer by removing only part of the bladder. With this procedure, the portion of the bladder where there is cancer is removed, and the hole in the bladder wall is then closed.

Radical cystectomy: If cancer is larger in size or is in more than one region of the bladder, then the entire bladder may need to be removed. With a radical cystectomy, nearby lymph nodes may also be removed, along with the prostate (for men), and, for women, the ovaries, fallopian tubes, uterus and a small part of the vagina. This type of bladder cancer surgery is an extensive procedure, but may help ensure that all cancer cells are removed from the body and reduce the likelihood of the disease recurring.