How Is A Tumor In The Bladder Removed

Bladder Cancer Surgery Approaches

There are three different surgical approaches to treating bladder cancer. What type of procedure your healthcare team recommends will depend on the size and location of the tumor, the stage of the cancer and other considerations. The types of surgery include:

Transurethral resection of bladder tumor : Used as the initial diagnostic procedure in most people with bladder cancer, this procedure is also used as a treatment method for some early-stage small or superficial cancers that have not invaded the muscle of the bladder.

During the surgery, a thin, rigid tube equipped with a light and camera is inserted through the urethra and fed up into the bladder. Other instruments can also be passed through the cystoscope to help remove a tumor and control bleeding.

Partial cystectomy: Also called “bladder preservation surgery,” this procedure involves removing only part of the bladder. It is done infrequently and only in a few special situations, such as when the tumor is small or easy to access, if the tumor has not spread, or if the tumor invaded the muscular layer of the bladder, but in only one place. Since much of the bladder remains, reconstructive surgery is not required, though follow-up surgery may be needed to fully restore function.

Removing Part Of The Bladder

Removing part of the bladder is not a common operation for bladder cancer. It is usually a treatment for a 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.

Managing Life After Bladder Removal

It takes some time to adjust to the changes after bladder removal. Its not uncommon for patients to have difficulty controlling their bladder following surgery, depending on the urinary diversion that is done. For this reason, incontinence pads or briefs may need to be worn for a period of time. Patients can also expect regular follow-up care and appointments to ensure the urinary diversion drains appropriately.

Doctors typically advise restricting certain strenuous activities until about six weeks post-surgery. These activities include lifting, driving, bathing, and even working, depending on your profession.

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Bladder Reconstructions And Stomas

If you have had your bladder removed, the way you pass urine will change. There are several options that your treatment team will talk to you about:

• Urostomy is where doctors create a new hole in your abdomen called a stoma. Urine drains from the stoma to the outside of your abdomen into a special bag.
• Neobladder is where a new bladder made from your small bowel forms a pouch inside your body to store urine. You will pass urine by squeezing your abdominal muscles. You will also pass a small tube into the neobladder each day to help drain the urine.
• Continent urinary diversion is a pouch made from your small bowel inside your body to store urine. The urine empties through a hole called a stoma to the outside of your abdomen into a special bag.

A bladder reconstruction is a big change in your life. You can speak with a continence or stomal therapy nurse for help, support and information. You can also call Cancer Council . You may be able to speak with a trained Cancer Council volunteer who has had cancer for tips and support.

If you find it difficult to adjust after your bladder reconstruction, it may help to be referred to a psychologist or counsellor.

Note: If you have a stoma, you can join a stoma association for support and free supplies. For more information about stoma associations, visit the Australian Council of Stoma Associations.

What Happens Before Bladder Surgery

Your healthcare provider may recommend you stop taking any medications that risk bleeding during your bladder surgery. You should stop the following medications about a week before:

NSAIDs, including:

• Acetylsalicylic acid .

Some antibiotics, blood pressure medications and herbal medications or supplements may also be restricted. Youll also be asked to stop smoking and using tobacco products. Besides the negative health consequences that smoking has, tobacco use can lead to higher risks both during and after surgery. Tobacco has been proven to slow down the healing process and decrease the effectiveness of the immune system.

Dont discontinue any medication without your healthcare providers instruction.

Your provider will likely recommend you change your diet the day before your surgery and follow a clear liquid diet starting the morning before your surgery. This includes juices without pulp, soup broth and Jell-O. Its also important to arrange for someone to care for you after surgery as returning to normal activity is not recommended immediately.

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Removing The Whole Bladder

A radical cystectomy means taking out the whole bladder and the nearby lymph nodes.

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.

Treating Stage 0 Bladder Cancer

Stage 0 bladder cancer includes non-invasive papillary carcinoma and flat non-invasive carcinoma . In either case, the cancer is only in the inner lining layer of the bladder. It has not invaded the bladder wall.

This early stage of bladder cancer is most often treated with transurethral resection with fulguration followed by intravesical therapy within 24 hours.

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Sexual Effects Of Radical Cystectomy In Women

If the surgeon takes out the end of the urethra where it opens outside the body, the clitoris can lose some of its blood supply, which might affect sexual arousal. Talk with your surgeon about whether the end of the urethra can be spared.

For more on ways to cope with these and other sexual issues, see Sex and the Woman With Cancer.

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Types Of Surgical Reconstruction To Replace The Removed Bladder

• Neobladder – UCLA is an innovator in the reconstruction of the urinary tract. In selected patients, a portion of the intestines is used to create a new bladder or neo-bladder. The ureters are joined to one end of the neo-bladder and the other end is connected to the remaining portion of the urethra. The new bladder is constructed in such a way that it will provide a reservoir to store urine and control urine flow.
• Continent Diversion – If the urethra is involved with cancer, it will need to be removed and some patients may benefit from creating a continent diversion, where one end of the new bladder will be brought out to the side of the abdomen to create a stoma without the use of an appliance bag. A small catheter is then passed through the stoma to drain out the urine and empty the new bladder 4 to 6 times a day.
• Ileal Conduit – Some patients are better served by creating a simpler ileal conduit. This is created using a shorter portion of intestine between the ureters to a stoma connected to the side of the abdomen. It acts as a funnel to drain urine from the kidneys to an appliance bag attached to the patients skin. It requires an ostomy bag, but is a shorter and simpler operation with the least chance of post-operative or long-term complications.

Where Can I Get More Information About A Radical Cystectomy

In Adapting to the New Normal, Darrell and Steven discuss how they maintained their quality of life after their bladder cancer diagnoses and subsequent surgical interventions. BCANs The New Normal: Living with a Urinary Diversion video series profiles eight bladder cancer survivors discussing their urinary diversion choice and sharing their experience to let others know about living well with a urinary diversion.

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Cystectomy Surgery Radical And Partial

• Open Radical Cystectomy
• Robotic Radical Cystectomy, which is the robotic-assisted, minimally invasive removal of the bladder, may be the optimal treatment for bladder cancer for aggressive or recurrent disease. The surgery typically includes removal of the surrounding pelvic lymph nodes. Often, the urinary diversion can also be completed robot-assisted laparoscopically.

What Is A Radical Cystectomy

Before any radical surgery is performed, a series of CT scans or an MRI will be ordered to exclude the possibility of metastatic or distant disease in other parts of the body. If the patient has metastatic disease, surgery to remove the bladder is not recommended and patients will be referred to a medical oncologist to discuss chemotherapy.

A radical cystectomy also involves creating a urinary diversion since the bladder is removed during the procedure. This urinary diversion involves using parts of the intestines to allow urine to pass from the kidneys to either an ileal conduit, urinary reservoir pouch called an Indiana Pouch, or a neobladder.

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Other Immunotherapies For Bladder Cancer

Researchers are testing other potential immunotherapy drugs to see how well they work on their own and combined with other treatments.

Theyâre also testing combinations of immunotherapies. Early results showed that nivolumab combined with another drug, ipilimumab, worked in 26% to 38% of people who took them.

Studies are also looking at atezolizumab in combination with another checkpoint inhibitor called MTIG7192A.

What Does The Bladder Do

Your urine bladder , stores your pee after your kidneys filter it. Pee goes from your kidneys down the ureters and into your bladder, where its stored before exiting your body through your urethra.

Your bladder is made of muscular, flexible tissues that can expand bigger or shrink smaller depending on how much pee it contains. The muscles in your bladder contract when they push your pee through your urethra.

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Cystoscopy With Cautery Destruction Of The Bladder Tumor

Cystoscopy is an outpatient procedure during which a thin, lighted tube with a camera is passed through the urethra into the bladder, allowing your doctor to see the inside of the bladder.

Most modern cystoscopes are also equipped with channels that permit small instruments to be passed into the bladder. During a cystoscopy, your doctor may use these instruments to remove tissue, stop bleeding with a special electrical device called an electrocautery or even perform laser treatment. If the bladder cancer tumor is small enough, this cautery may be used to remove the cancer.

Laser En Bloc Resection May Result In Better Diagnoses Fewer Recurrences Says Cedars

Patients with earlier-stage bladder cancer have a new surgical option to remove tumors. The procedure may improve staging accuracy, lower the risk of recurrence and reduce the rate of complications, according to a leadingCedars-Sinaiurologic oncologist.

Laser en bloc resection, or total tumor resection, enables surgeons to remove thebladder tumor in one piece. This novel procedure provides intact tissue for a pathologist to stage the cancer and reduces the risk of cancer remaining in the bladder, saidMichael Ahdoot, MD, aCedars-Sinai Cancerurologic oncologist and surgeon.

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Catheterizable Continent Diversion Pouch

This is a reservoir of bowel with a stoma that is catheterizable for emptying the bladder. The urine is siphoned out of the urinary reservoir with a small catheter every four to six hours. The catheterizable pouch may require surgical repair at some point after surgery due to the wear and tear of frequent catheterization. This type of reconstruction is not performed on patients with a history of bowel disease.

Health Assessment Care Plan For Bladder Cancer Patient

Theresa is a 37 year old who was diagnosed with bladder cancer. She recently commenced her course of chemotherapy .She rushes to the Emergency Room at 11.45pm complaining of having a fever.

Introduction

The nurse plays an important role in the management of the cancer patient undergoing chemotherapy. This case would look at the case of bladder cancer and how the nurse can plan interventions based on a comprehensive nursing assessment.

Bladder Cancer

Bladder cancer is cancer that occurs in the bladder and is about four different types based on cell type origin. These are transitional cell carcinoma , squamous cell carcinoma, adenocarcinoma and small cell carcinoma .

Transitional cell carcinoma is the most common type occurring in 97% of bladder cancer cases. It can be divided into two subtypes papillary tumors which grow toward the center of the bladder and flat carcinomas which involve the layers of cells lining the bladder wall .

Squamous cell carcinoma makes up about 1 to 2 % of bladder cancer types and these are invasive. Adenocarcinoma makes up about 1% and these are also invasive. Small cell carcinoma makes up less than 1% of the bladder cancer cases .

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Signs and Symptoms

Treatment

Side Effects of Treatment

Nursing Assessment

Physical Assessment

Nursing Diagnoses

Nursing Care Plan

Goals

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How Common Is Bladder Surgery

Almost 85,000 people are expected to be diagnosed with bladder cancer in 2021. Its the sixth most common cancer in the United States and the third most common cancer for males. Bladder surgery is typically part of the treatment plan for bladder cancer. Radical cystectomy where your entire bladder is removed is the type of bladder surgery used for muscle-invasive bladder cancer .

Radiotherapy With A Radiosensitiser

Radiotherapy is given by a machine that beams the radiation at the bladder . Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes.

A medicine called a radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This medicine affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue.

As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:

• erectile dysfunction
• difficulty passing urine

Most of these side effects should pass a few weeks after your treatment finishes, although there’s a small chance they’ll be permanent.

Having radiotherapy directed at your pelvis usually means you’ll be infertile .

After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy.

You may also be offered CT scans of your chest, abdomen and pelvis after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years.

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Types Of Bladder Cancer

Bladder cancer can be described based on where it is found:

• non-muscle invasive the cancer has not spread to other layers of the bladder or muscle
• muscle-invasive the cancer has spread to other layers of the bladder, muscle or other parts of the body.

There are 3 main types of bladder cancer:

• urothelial carcinoma 80 to 90% of bladder cancers sometimes called transitional cell carcinoma
• squamous cell carcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive
• adenocarcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive .

There are other, less common types of bladder cancer. Treatment for these may be different. Speak to your doctor or nurse for information about these types of cancer.

When You Might Have A Turbt

TURBT is the main treatment for non muscle invasive bladder cancer. You usually have this operation as your first treatment.

TURBT can also diagnose bladder cancer and find out whether the cancer has spread into the muscle layer of the bladder wall. The surgeon removes the tumour . They send the tissue they remove to the laboratory. This tells them:

• how far the cancer has grown through the bladder wall
• how abnormal the cancer cells look under the microscope

You sometimes have a second TURBT operation within 6 weeks of the first. You usually have this if you have a high risk non muscle invasive bladder cancer. This is to make sure the surgeon has removed all the cancer. And to double check how far your cancer has grown.

• Read more about high risk non muscle invasive bladder cancer

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Should I Be Careful With What I Eat Or Drink With A Urostomy

No, just drink plenty of fluids, like water. Itâs best to limit caffeine and alcohol, because theyâre less likely to keep you hydrated. Thatâs important to lower your chance of infection.

Go easy on beverages near bedtime, and attach a larger night drainage bag to hold more urine while you sleep.

Your pouch is odor-proof, so you wonât smell anything until you empty it. If your pee has a very strong odor, it could be a sign of an infection. But other things can affect the smell, too:

• Foods, like asparagus, coffee, fish, garlic, and onions
• Medicines, such as antibiotics
• Supplements, like vitamins