Tumors which have invaded into the muscle of the bladder pose a significant and life-threatening risk to patients. These tumors inevitably spread through the body and if not treated before this occurs day become incurable (see Treatment – Systemic below). In fact, up to half of patients who are believed to have muscle invasive bladder tumor without spread to the rest of the body based on imaging tests will in fact have microscopic spread of the disease elsewhere.
For this reason, the treatment of these tumors is very aggressive since the alternative is likely death from the eventual spread of the cancer through the body. The mainstay of treatment is removal of the bladder. This treatment is called a radical cystectomy - you can find extensive information on this treatment option here.
Treatment Options for Muscle Invasive Bladder Cancer
- Radical Cystectomy and Urinary Reconstruction
- Radiation and Chemotherapy
- Partial cystectomy (very limited application)
Alternatives to radical cystectomy are the 'bladder preservation' approaches: radiation plus chemotherapy or aggressive transurethral resection of the tumor or partial removal of the bladder (partial cystectomy). Bladder preservation approaches are used in select circumstances.
Additional treatment in the form of chemotherapy is often times administered prior to removal of the bladder or in conjunction with radiation. When chemotherapy is given prior to the main treatment is it called NEOADJUVANT. When chemotherapy is given after the main treatment it is called ADJUVANT. The duration of chemotherapy is 3-4 months. In select circumstances this can increase the chances that surgery or radiation will cure the bladder cancer. Is well tolerated in most patients though sometimes it can be associated with serious and significant side effects.
Once the bladder is removed, some sort of reconstruction of urinary tract is required to allow the urine to exit the body. You can find extensive information on reconstruction here. There are 2 major decisions which need to be made:
- Orthotopic (in the same location as the bladder used to be) or ectopic (in another area of the abdomen)
- Continent (requiring volitional voiding or catheterization) or non-continent (freely flowing requiring constant use of a collection bag)
A discussion with your urologist will clarify which would work best for you. In simple terms, the ileal conduit is similar to a Toyota in that is not fancy but tends to be quite reliable and simple with a lower chance of needing revision surgery (about 10% over 10 years). The Studer neobladder it is more like a Jaguar in that when it works dear fantastic but require more maintenance and are more likely to require revision surgery (about 10% over 10 years).
It is important to note that sexual function is always affected in both men and women following cystectomy.Your urologist is there to talk about these issues if they are important to you.
In males, the effects on erectile function are similar to those men undergoing radical prostatectomy (since the prostate is also removed with a radical cystectomy). Nerve-sparing surgery can be performed in select circumstances and some men will retain their ability to obtain erections on their own. Men who are younger and have good pre-operative erectile function are most likely to retain sexual function with nerve sparing. Almost all men, however, will see a decline in their ability to achieve an erection and it is common for the men who do retain erections to require a medication such as Viagra. There are other ways to obtain erections including injections, vacuum constriction devices and penile prostheses. All men lose the ability to ejaculation - and consequently the ability to have children with intercourse.
In females, the vagina is oftern decreased in length and size. Sometimes the nerves responsible for sexual stimulation are affected by surgery.
