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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Transurethral Resection Of The Bladder Cancer Tumor
This is when the tumor is removed from the urinary tract through the urethra using an electrical force. Transurethral resection is an endoscopic or scope procedure that does not involve making an incision in the body.
Drug therapy after TUR is commonly prescribed for patients with large, multiple or high-grade tumors.
Patients May Want To Think About Taking Part In A Clinical Trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of todays standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
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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.
Follow Up After Turbt
Any further treatment you have after TURBT depends on the risk of the cancer coming back and if it has spread into the bladder wall. Your surgeon and healthcare team will discuss this and then meet with you to explain your options. They will talk you through the risks and benefits of further procedures and treatments.
Further treatments may include:
- regular cystoscopies to check that the cancer hasnt come back
- another TURBT
- a course of at least six more treatments of chemotherapy put into your bladder
- an immunotherapy treatment called BCG put into your bladder
- surgery to remove your bladder
- radiotherapy or chemotherapy
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Treating Stage Ii Bladder Cancer
These cancers have invaded the muscle layer of the bladder wall , but no farther. Transurethral resection is typically the first treatment for these cancers, but it’s done to help determine the extent of the cancer rather than to try to cure it.
When the cancer has invaded the muscle, radical cystectomy is the standard treatment. Lymph nodes near the bladder are often removed as well. If cancer is in only one part of the bladder, a partial cystectomy may be done instead. But this is possible in only a small number of patients.
Radical cystectomy may be the only treatment for people who are not well enough to get chemo. But most doctors prefer to give chemo before surgery because it’s been shown to help patients live longer than surgery alone. When chemo is given first, surgery is delayed. This is not a problem if the chemo shrinks the bladder cancer, but it might be harmful if the tumor continues to grow during chemo.
If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn’t given before surgery.
For people who have had surgery, but the features of the tumor show it is at high risk of coming back, the immunotherapy drug, nivolumab, might be offered. When given after surgery, nivolumab is given for up to one year.
For patients who cant have surgery because of other serious health problems, TURBT, radiation, chemotherapy, or some combination of these may be options.
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
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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.
What Is Lymph Node Dissection
Lymph node dissection is generally performed at the same time the surgeon performs a cystectomy.1,2 During lymph node dissection, the surgeon removes lymph nodes in the patients pelvis. The lymph nodes are then analyzed in the laboratory to see if there are cancer cells present. This is an important tool for staging a patients bladder cancer, because bladder cancer cells can travel from lymph nodes in the pelvis to other parts of the body through the lymphatic system.
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Genetic Risk Assessment Program
The UCLA Genitourinary Cancer Genetic Risk Assessment Program focuses on investigation into the potential genetic causes of an individuals urologic cancer. Up to 5-10% of cancers are related to a genetic predisposition. If you have been diagnosed with a urologic cancer, UCLAs team has specific referral criteria to determine if you should pursue genetic risk assessment to evaluate for a genetic cause of cancer. For those at greatest risk, often this knowledge can more precisely tailor a treatment plan that is optimal for you.
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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Treatment For Upper Tract Low Grade Urothelial Cancers Using Mitogel
Urothelial cancer is a cancer that develops in the lining of the urinary system. While most urothelial cancers appear in the bladder, upper tract urothelial cancers develop in the lining of the kidney or the ureter . UTUC can block the ureter or kidney, causing swelling, infections and impairment of kidney function in some patients. At UCLA we offer Jelmyto , a non-surgical therapy approved by the U.S. Food and Drug Administration for treatment of low-grade UTUC. Many of the initial studies for Jelmyto that led to the FDA approval were developed at UCLA.
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.
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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.
Transurethral Resection Of Bladder Tumor
A transurethral resection of bladder tumor or a transurethral resection is often used to find out if someone has bladder cancer and, if so, whether the cancer has spread into the muscle layer of the bladder wall.
TURBT is also the most common treatment for early-stage or superficial bladder cancers. Most patients have superficial cancer when they’re first diagnosed, so this is usually their first treatment. Sometimes, a second, more extensive TURBT is done to better ensure that all the cancer has been removed. The goal is to take out the cancer cells and nearby tissues down to the muscle layer of the bladder wall.
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What Happens During The Surgery
At the start of the procedure, you will be given a numbing drug . Generally, two options are available: general anesthesia where you take a nap for the entire procedure, or local anesthesia, where you remain awake, but are given a drug through a needle in your back to numb the lower half of your body.
During a TURBT procedure, the surgeon inserts a tool called a resectoscope through the urethra to reach the inside of your bladder. This tool has a surgical loop on it that resects or cuts off a sample of tumor tissue to be analyzed by a pathologist, or resects the entire tumor from your bladder . TURBT is used as a treatment for patients with early-stage bladder cancer, and is typically followed by intravesical therapy.
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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Doctor Visits And Tests
Your schedule of exams and tests will depend on the stage and grade of the cancer, what treatments youve had, and other factors. Be sure to follow your doctors advice about follow-up tests.
Most experts recommend repeat exams every 3 to 6 months for people who have no signs of cancer after treatment. These are done to see if the cancer is growing back or if theres a new cancer in the bladder or urinary system. Your follow-up plan might include urine tests, physical exams, imaging tests , and blood tests. These doctor visits and tests will be done less often as time goes by and no new cancers are found.
- If your bladder hasnt been removed, regular cystoscopy exams will also be done every 3 months for at least the first 2 years.
- If you have a urinary diversion, you will be checked for signs of infection and changes in the health of your kidneys. Urine tests, blood tests, and x-rays might be used to do this. Your vitamin B12 will be checked at least once a year because urinary diversions made with your intestine can affect B12 absorption. Your doctor will also talk to you about how well youre able to control your urine. Tests will be done to look for signs of cancer in other parts of your urinary tract, too.
Some doctors recommend other lab tests as well, such as the urine tumor marker tests discussed in Can Bladder Cancer Be Found Early? Many of these tests can be used to help see if the cancer has come back, but so far none of these can take the place of cystoscopy.
Milestones In My Recovery Process
As an example here are some of the milestones in my recovery process:
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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.
In people with female anatomy, the uterus, fallopian tubes, and sometimes the ovaries and part of the vagina may also be removed. In people with male anatomy, the prostate, seminal vesicles, and part of the urethra may be removed.
Types Of Surgical Techniques
- Endoscopic surgery: A thin, flexible tube equipped with a camera and surgical tools is inserted into a natural opening so no incision is made in the skin.
- Keyhole surgery: This minimally invasive procedure involves several small incisions in the skin to access the bladder, and the cancer is removed through these holes using special instruments.
- Robotic surgery: Similar to keyhole surgery, robotic surgery differs in that the actual surgery is done via mechanized instruments instead of a surgeon’s hands controlling the instruments.
- Open surgery: With an open approach, a traditional large incision is made in the abdomen to access the bladder.
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