Adrenal Cancer
Overview
The majority of bladder cancers in the United States are called transitional cell carcinomas (TCC). Less commonly, adenocarcinoma or squamous cell carcinoma occurs in the bladder. Cystoscopy is perfomed to look inside the bladder, and a biopsy is performed to confirm the diagnosis of bladder cancer. In certain cases, the tumor can be removed using a cystosope in a procedure called a transurethral resection (TUR). Patients typically go home the same day after a TUR. If select cases of bladder cancer, a TUR is the only treatment needed. Periodic cystoscopy is then performed to monitor for recurrences in the bladder. For select cases of bladder cancer in which the tumor is invasive into the bladder wall, more extensive surgery is required.
When bladder cancer invades into the wall of the bladder, standard treatment involves complete removal of the bladder. Removing the bladder in its entirety is called a radical cystectomy. In addition, the lymph node of the pelvis are removed. After the bladder is removed, there are several methods of reconstructing the urinary tract, all of which involve constructing a "new bladder" from a segment of intestine. The most basic reconstruction is referred to as an ileal conduit, in which urine from the kidneys drains to a pouch made from intestine, then comes up to the skin in the form of a stoma, and then drains freely into an ostomy bag. An alternative reconstruction is a continent diversion; in this case there is also a stoma created on the abdomen, but it does not drain into a bag. Instead, the patient introduces a thin plastic catheter into the stoma several times a day to drain the urine. The third reconstruction option is referred to as a neobladder. A neobladder is a new bladder constructed out of intestine and connected back to the urethra. This allows the patient to void, or urinate, out of their urethra. Choosing the right diversion is a complex decision; speak with your surgeon about what approach is best for you.
Radical cystectomy, lymph node dissection, and urinary reconstruction can be performed by traditional "open" surgery. This involves an incison from the pubis extending slightly above the umbilicus ("belly button"). Alternatively, this operation can be performed robotically using the daVinci robotic surgical system. Similar to laparoscopy, the robotic cystectomy involves several small incisions (5 - 10 mm) and the use of a telescope to perform the cystectomy; often an incision extending from the pubis to below the umbilicus is required to complete the urinary diversion.
Treatment for bladder cancer depends on the stage of the disease, the type of cancer, and the patient's age and overall health. Options include surgery, chemotherapy, radiation, and immunotherapy.
