Bladder cancer can present with various complaints including pain, irritation, and difficulty urinating. However, by far the most common symptom is blood in the urine, known as hematuria. Sometimes the bleeding is very minor and can only be seen under the microscope. Other times it is more significant and can be seen by the patient. This is often alarming to the patient and family. It is important to have a thorough urologic evaluation for hematuria because of the risk for bladder cancer.
Evaluation of hematuria usually involves a CT scan with contrast and a cystoscopy. A cystoscopy is an endoscopic procedure done to visually evaluate the inside to the bladder. It is performed with local numbing medicine in our procedure hall and is a quick (generally less than 2 minutes) procedure.
A bladder tumor found during cystoscopy is first managed by endoscopic surgical resection of the tumor. This will provide a pathologic staging of the tumor and in a majority of cases also treat the cancer. Occasionally a repeat resection may be indicated if your tumor was large, not completely resected, or high grade and/or stage.
Bladder cancer arises from the mucosal lining on the inside of the urinary bladder. The various stages of bladder cancer range from a caner that is not invasive at all to one that is invading all the way through the bladder. A significant finding is cancer growing into the muscle of the bladder wall as this will generally change the management approach.
Depending on the stage and grade of your tumor, you may be offered treatment to decrease the risk of cancer recurrence. Most commonly, BCG ( a weakened bacteria) is instilled into your bladder. Your body will create an immune response to attack the BCG and this will also attack abnormal bladder cells. This will be done once a week for six weeks and if you respond well may be continued intermittently over a several year course. Side effects are generally mild irritative voiding symptoms, although a fever should prompt a call to your doctor. Bladder cancer is notorious for recurring and lifelong surveillance is always recommended.
If the cancer is invading into the muscle layer of the bladder, or if you have responded poorly to other treatment options, surgical removal of the bladder is considered. This is referred to as a cystectomy. As the bladder is removed, a new organ has to be created to get your urine out of your body. There are two main options to do this. First is an ileal conduit, where a piece of small bowel is used to divert the urine out a small rosebud opening (known as a urostomy) on the belly and urine collects in a bag that can be emptied as needed. The second is a neobladder, which literally means “new bladder.” This uses the small bowel to create a new pouch to hold urine until you are ready to void. While a neobladder seems appealing at first, there are more complications and post-operative problems with it than the ileal conduit. You should discuss both these options with your surgeon including risks and benefits of each.
Today cystectomies are being done laparoscopically with assistance of the Robot. Patients have less pain, less bleeding, a smaller incision, and a shorter hospital stay with use of the Robot.
To learn more about robotic surgery, click here.