Treating Bladder Cancer That Progresses Or Recurs
If cancer continues to grow during treatment or comes back after treatment , treatment options will depend on where and how much the cancer has spread, what treatments have already been used, and the patients overall health and desire for more treatment. Its important to understand the goal of any further treatment if its to try to cure the cancer, to slow its growth, or to help relieve symptoms as well as the likely benefits and risks.
For instance, non-invasive bladder cancer often comes back in the bladder. The new cancer may be found either in the same place as the original cancer or in other parts of the bladder. These tumors are often treated the same way as the first tumor. But if the cancer keeps coming back, a cystectomy may be needed. For some non-invasive tumors that keep growing even with BCG treatment, and where a cystectomy is not an option, immunotherapy with pembrolizumab might be recommended.
Cancers that recur in distant parts of the body can be harder to remove with surgery, so other treatments, such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy, might be needed. For more on dealing with a recurrence, see Understanding Recurrence.
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What Is A Cystectomy
If bladder cancer is invasive, either part or all of the bladder may need to be removed. This procedure is called a cystectomy.
In a partial cystectomy, only part of the bladder wall is removed, and the bladder is closed with sutures. Nearby lymph nodes are removed, often along with the prostate in men. In women, often the ovaries, fallopian tubes, uterus, cervix, are removed as well.
When the bladder is completely removed , a new way for urine to pass out of the body will need to be constructed. This can be done in multiple ways, including:
- Ileal conduit: In this procedure, a new passageway that allows urine to drain to a bag outside of the body is created. To do this, a surgeon will remove a piece of intestine and attach it to the ureters . Then the intestine tube is connected to an opening in the surface of the skin , and a bag to catch urine as it drains out is placed on the outside of the opening on the stomach.
- Neobladder: In this procedure, a new bladder is made using part of the intestine. It is then attached to the ureters, so urine can drain from the kidneys and into the neobladder. The urethra is attached to the neobladder, and urine leaves the body through the urethra.
Both partial and total cystectomy typically require an inpatient stay in the hospital, usually for about one week.
Transurethral Resection Of Bladder Tumour
This information is designed to help you, your family and friends prepare for your surgery. It will also help you plan how to take care of yourself in the weeks following discharge from hospital.
The bladder sits low within the pelvis and stores urine. It has two ureters that join to it from above, that transport urine from the kidneys. The urethra exits from the bottom of the bladder and through this, urine is passed to empty the bladder.
The Urologist has determined from the various tests you have had that it is likely that you have a bladder tumour and that surgical removal of the cancer is required.
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Risks Of Transurethral Resection
There are a few risks that are associated with Transurethral Resection . Some men will require a follow-up treatment after Transurethral Resection because symptoms may return. After the procedure, you may have trouble urinating for a few days following the procedure. Until you are able to urinate on your own, you will have a catheter. A catheter will be inserted into the penis and will carry urine out of the bladder. A urinary tract infection is possible after any prostate procedure. This infection becomes more common the longer the catheter is in place. In rare cases, erectile dysfunction is possible. Heavy bleeding is possible after the procedure. In rare cases, men will lose enough blood to require a blood transfusion. Rarely, men will lose control of their bladder. Lastly, it is very rare that the body will absorb too much of the fluid that is used to wash the surgery during Transurethral Resection . This condition is called TURP syndrome or TUR syndrome. It can become life-threatening if it is not treated.
When You Wake Up After Your Operation
After a big operation, you may wake up in the intensive care unit or a high dependency recovery unit. You usually move back to the ward within a day or so.
In intensive care you have one to one nursing care. In the high dependency unit you have very close nursing care. Your surgeon and anaesthetist review you regularly and watch your progress closely.
These units are busy and often noisy places that some people find strange and disorientating. You’ll feel drowsy because of the anaesthetic and painkillers.
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Removing The Whole Bladder
A radical cystectomy means taking out the whole bladder and the nearby lymph nodes.
In men, the surgeon also removes the prostate gland and glands that store semen . This is because bladder cancer can come back in this area. In women, the surgeon usually removes the womb and fallopian tubes. Sometimes the surgeon removes your ovaries and part of your vagina. Your surgeon talks this through with you beforehand.
You may also have part of your bowel removed. This is so your surgeon can create another way for your body to collect and pass urine. Its called a recto sigmoid pouch. Your surgeon will discuss this with you beforehand if youre having this operation.
Why Is Transurethral Resection Done
Transurethral Resection is able to reduce the urinary symptoms that is caused by benign prostatic hyperplasia, or BPH. Some of these symptoms are:
- Difficulty starting to urinate
- The feeling that you cannot empty your bladder
- Stopping and starting again while urinating
- Increased urination at night
Transurethral Resection is also done to treat or prevent complications that occur with the blocked urine flow. These complications include:
- Blood in the urine
- Inability to urinate
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Removing Part Of The Bladder
Removing part of the bladder is not a common operation for bladder cancer. It is usually used to treat the very rare type of cancer called adenocarcinoma of the bladder.
After having a partial cystectomy, you can pass urine in the normal way. But your bladder will be smaller so you may need to go to the toilet more often.
I Had No Idea What To Expect
Going into this surgery I had no idea what to expect. It was very uncomfortable at some points to have the catheter in but I think this was because it may have been touching a tender spot in my bladder. Some people tell me they had no problem with it.
Following the TURBT, the normal procedure is to have chemo injected directly into your bladder for 6 weeks. The two medications used are BCG and Mitomycin. I, personally, am allergic to both so I cannot have any type of treatment to prevent recurrence so I have a cystoscopy every three months and a TURBT every three months.
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How Do You Prepare For A Turbt
Normally, you have to stop eating and drinking the night before any procedure that requires anesthesia. Make sure your provider knows about all of the medications that you take, including over-the-counter medicines and supplements.
Your healthcare provider will tell you if you need to avoid taking any of your medication for instance, blood thinners and when you should stop. Dont just stop taking medication without discussing it with your provider.
If youre allowed to take medications in the morning before the TURBT, make sure you only take a sip or two of water.
Take a bath or shower before you go in for the procedure. Dont use any kind of lotions or perfumes or deodorants after your shower.
Dress comfortably the day of the procedure. Bring identification, but leave your money, credit cards and jewelry at home.
Bring someone who can drive you home. Between anesthesia and pain medication, it wont be safe for you to drive yourself.
About One Third Had Cancer Recurrence
Of these patients, 548 had bladder cancer recurrence, most of whom experienced recurrence in the first 5 years after their radical cystectomy . Late recurrence occurred in 67 of study patients. The average amount of time to bladder cancer recurrence was 12 months, with 80% of recurrences happening in the first three years. These 548 recurring bladder cancer patients account for about 33% of the study patients who were treated, which is less than the national average of 50% of patients having bladder recurrence.
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Can I Shower Bathe And Swim With A Urostomy
A stoma is a one-way door, so waterâs not a problem. You can shower and bathe with or without your pouch. But itâs best not to use bath oils or soaps with moisturizer.
Swimming isnât a problem, either. It helps to:
- Wear a smaller bag or a waterproof cover when you swim.
- Wear your pouch, but empty it before you get into the water.
- Use waterproof tape around the edges of the pouch.
- Wait a few hours after you put on a new pouch before you swim.
What Was Your Turbt Experience Like
Best of luck to those of you just joining the club no one wants to join but please let me know how your TURBT goes and any suggestions you may have to help others in the comments below, or with the community.
Editorâs Note: We are extremely saddened to say that on January 28, 2020, Jennifer Toth passed away. Jennifer was a passionate advocate for the bladder cancer community. She will be deeply missed.
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Milestones In My Recovery Process
As an example here are some of the milestones in my recovery process:
What Is Bladder Surgery
Bladder surgery is the repair of the bladder through surgical means. In some cases, the bladder needs to be removed. In its place, surgeons reconstruct the bladder with intestinal tissue. Doctors sometimes recommend bladder surgery for urinary incontinence, bladder cancer, and cystocele. There are different types of bladder surgery, so the procedure one goes through depends on the type of surgery.
If a new bladder is needed, surgeons will remove a segment of the intestines and create a bladder from it and attach it to the ureters. The ureters are a duct through which urine travels from the kidneys to the bladder, or new bladder in this case. This bladder varies in size from a small pouch to the size of an original bladder. Many patients prefer this option because it allows the urine to exit their bodies in a way theyre used to rather than having to empty a bag. The other option is a leak proof bag that is connected to a tube, known as a stoma, and brought to the skin for collecting the urine. Patients can empty the bag as needed.
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Trans Urethral Removal Of Bladder Tumour
A trans urethral resection of bladder tumour is usually the first treatment you have for early bladder cancer.
Your surgeon removes the tumour in your bladder through the urethra. The urethra is the tube that carries urine from the bladder to the outside of your body.
You might have TURBT to remove early bladder cancer:
- during a cystoscopy test if your specialist sees a tumour
- after having tests that have shown a bladder tumour
You usually have it under general anaesthetic, which means you are asleep. In some hospitals, you may have a spinal anaesthetic instead of a general anaesthetic. This is an injection into your spine so you cant feel anything from below your waist.
This treatment takes between 15 to 90 minutes.
Who Can Use Bcg
BCG is a treatment for early-stage bladder cancer that has not yet invaded the muscle of the bladder wall. Called non-muscle invasive bladder cancers or in situ bladder cancers, these account for about half of all bladder cancers.
For 2021, it was estimated that about 83,730 new cases of bladder cancer would be diagnosed in the United States, and about 17,200 American bladder cancer patients would die from the disease.
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Continent Diversion With A Continent Diversion You Control Urination The Surgeon Makes A Pouch To Hold The Urine You Drain The Urine From This New Pouch Either With A Tube Or Through The Ureter A Continent Cutaneous Reservoir Is Also Called A Continent Diversion With Catheterizable Cutaneous Stoma The Surgeon Creates A Pouch Using The Right Side Of The Colon And A Piece Of The Small Intestine The Pouch Is Attached To An Opening Made In The Abdominal Wall And Skin You Drain Urine From The Pouch By Inserting A Tube Into The Opening Several Times Throughout The Day
An orthotopic neobladder is when the surgeon makes a pouch usually from part of the small intestine. The ureters are attached to the pouch, which is then attached to the urethra. You empty the pouch by urinating normally. An orthotopic neobladder is a more difficult type of surgery than other urinary diversions and there is more chance of problems . So it is usually done in younger people without serious medical problems.
Find out more about .
Bladder Cancer Clinical Trials
Major drug companies continually research and develop new medications and treatments for bladder cancer that must be shown to be safe and effective before doctors can prescribe them to patients. Through clinical trials, researchers test the effects of new drugs on a group of volunteers who have bladder cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat bladder cancer, its safety, and any possible side effects.
Some patients are reluctant to take part in clinical trials for fear of getting no treatment at all. But patients who participate in clinical trials receive the most effective therapy currently available for the condition, or they may receive treatments that are being evaluated for future use. These bladder cancer drugs may be even more effective than current treatment. Comparing them in a clinical trial is the only way to find out.
Hereâs where to find information about whether a bladder cancer clinical trial is right for you.
This website lists industry-sponsored clinical trials that are actively recruiting patients.
American Cancer Society: âBladder Cancer Treatment,â âBladder Cancer Surgery,â âRadiation Therapy for Bladder Cancer,â âChemotherapy for bladder cancer,â âFDA Approves New Immunotherapy Drug for Bladder Cancer,â âImmunotherapy for bladder cancer.â
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How To Prepare For Transurethral Resection
Before your surgery, your physician will ask that you end your medications that are used as blood-thinners. You will likely be given an antibiotic to prevent a urinary tract infection after the surgery. Typically, you are able to go home after the surgery, so you will need someone to drive you home. You should not work or do any strenuous activity for up to six weeks after the surgery. Your physician will be able to give you a better expectation of how much recovery time you will need.
The procedure will take between sixty to ninety minutes. You will be given general anesthesia. This means that you will be asleep for the duration of the surgery. If your physician recommends a spinal anesthesia, then you will be awake but not feel anything.
During the procedure, your physician will insert a resectoscope into the top of the penis and will be extended through the urethra. There will be no incisions on the body. The resectoscope will be used to trim the tissue from in the prostate. When these pieces are cut, an irrigating fluid will carry them into the bladder. They will be removed.
After surgery, your physician will likely recommend the following:
- Avoid taking your blood-thinning medications until your physician says otherwise
- Drink a lot of water to flush out the bladder
- Eat high fiber foods as you will not want to strain during a bowel movement
- Avoid strenuous activities
- Do not drive until your catheter has been removed