invasive bladder cancer

This type of cancer needs major treatment.

You may be offered:

• surgery
• radiotherapy
• chemotherapy

or two or three of these treatments combined.

Surgery

Transurethral Resection of a Bladder Tumour (TURBT or TURT)
In a small number of people, it may be possible to treat invasive bladder cancer by a transurethral resection of a bladder tumour. The surgeon passes an instrument called a resectoscope through the urethra and into the bladder, and takes the cancer out through the tube. You will normally have a general anaesthetic for this, and will stay in hospital for two or three days. For most people, the treatments listed below are more suitable.

Radical or total cystectomy
This is an operation to take out the whole of the bladder to try to get rid of the cancer.

Other body organs will also need to be removed.

In women, the doctor will take out:

• the bladder
  
• the urethra
  
• the lower end of the ureters
  
• part of the front of the vagina
  
• the uterus (womb)
  
• the fallopian tubes
  
• the ovaries (in younger women the ovaries will be left in, if at all possible)
  
• the lymph nodes in the pelvis.

The operation may make the vagina shorter and narrower. Sexual feeling and climax may be affected.

In men, the doctor will take out:

• the bladder
  
• the prostate gland
  
• the lower ends of the ureters
  
• the urethra (sometimes)
  
• the lymph nodes in the pelvis.

Sometimes it is impossible to avoid damaging the nerves and blood vessels in the pelvis. Some men will not be able to get an erection. Sexual feeling and climax may be affected. Sometimes this can be treated with surgery or injections.

Removing the bladder is major surgery and you will stay in hospital for two or three weeks. There is a risk of complications. Around 3 in every 100 patients don’t survive the operation, and one or two in every ten will need further surgery later on. Your doctor will discuss all the risks with you.

If your bladder is removed you will need to have a new way of collecting the urine your body makes.

You may be offered:

Urostomy or ileal conduit
The surgeon makes an opening in the wall of the abdomen. The opening is called a stoma. You wear a bag fixed to the opening to collect your urine. When it gets full you empty it down the toilet, through a tap in the bottom of the bag.

Continent pouch
The surgeon makes a new bladder using some of your bowel. The new opening for your bladder will be on the wall of your abdomen, not in the usual place. You then empty your new bladder several times each day through a tube called a catheter.

Bladder reconstruction
The surgeon makes a new bladder using some of your bowel. The new bladder lies in the pelvis and is attached to your urethra. If you have this type of operation you will probably still be able to pass urine in the usual way, although you may have to empty the bladder using a catheter.

The Stoma Nurse Specialist is available to give advice, support and practical help to patients who are facing one of these options. When your doctor first discusses surgery with you, s/he should introduce you to your stoma nurse, or give you his/her contact details. If your doctor doesn’t do this, please ask.

Radiotherapy

Radiotherapy uses radiation to kill cancer cells. It is an alternative to surgery.

If you have invasive bladder cancer you will go for a radiotherapy treatment session every day (Monday-Friday) for six weeks. The treatment can have unwanted side effects (eg tiredness, diarrhoea or discomfort when you pass urine) but these usually settle down a few weeks after the treatment has finished.

Chemotherapy

Chemotherapy uses special drugs to kill cancer cells.

Your doctor may advise you to have chemotherapy either before or after your surgery. If so, you are likely to have chemotherapy once a week for two, three or four weeks – then this course of treatment is repeated 3-6 times. The drugs are injected into a vein. You can have most of your treatment as an outpatient.

If the bladder cancer has spread to other parts of your body, you may have chemotherapy to treat these secondary tumours.

Some patients may be offered chemotherapy combined with radiotherapy, as part of a clinical trial.

Chemotherapy can cause unwanted side effects, but they normally settle down after treatment has finished.