How aggressive is my cancer?
The aggressiveness or grade of bladder cancer is determined by the pathologist
who examines the cancerous tissues under a microscope. This tissue can
be obtained with biopsy or after surgical removal of the tumor. After
you are diagnosed, your doctor may do some additional tests-including a
bone scan or
chest X-ray-to find out the stage of the cancer.
The stages of bladder cancer include:
- Stage I: Cancer is in the inner lining of the bladder but hasn’t
entered the bladder wall.
- Stage II: Cancer has entered the bladder wall and is still confined to
- Stage III: Cancer cells have spread through the bladder wall to the surrounding tissue.
- Stage IV: Cancer cells may have spread to the lymph nodes and additional
organs including your bones, lungs or liver.
What are my treatment options?
Also called immunotherapy, biological therapy is the use of certain drugs
that signal your body’s immune system to fight cancerous cells.
Your doctor will recommend the most appropriate course of treatment for you.
Chemotherapy treatment for bladder cancer often combines two or more drugs
to destroy cancerous cells. It can be used prior to or after surgery.
When administered before surgery, chemotherapy is generally used to shrink
the size of a tumor enabling a minimally invasive surgery. When administered
after, chemotherapy is intended to kill any remaining cancer cells.
Radiation therapy aims high-energy beams directly at the cancerous cells
to eradicate the cancer.
Radiation is sometimes used following surgery to destroy any remaining
cancerous cells or, in certain cases, can be combined with chemotherapy
when surgery has been ruled out as an option.
Hoag offers a robust
Radiation Oncology Program, utilizing multiple treatment options to accurately administer radiation
therapy. Providing treatment in both Newport Beach and Irvine, Hoag's
Radiation Oncology team consists of highly specialized radiation oncologists,
physicists, dosimetrists, radiation therapists, radiation oncology nurses
and many support team members, such as speech and swallowing therapists
and oncology deititians.
The first-line surgical treatment for bladder cancer is the
trans-urethral resection of bladder tumor (TURBT). This involves the placement of endoscopic instruments into the bladder
via the urethra. The tumor is then removed from the wall of the bladder
and is examined by the pathologist to confirm the presence of cancer and
also depth of penetration and grade of cancer.
Segmental cystectomy, or partial cystectomy, is performed only in limited circumstances in
which the cancer is confined to a single area of the bladder.
Radical cystectomy is a surgery in which the entire bladder is removed, as well as adjacent
lymph nodes. In men with invasive bladder cancer, the prostate and seminal
vesicles are also removed. In women, the uterus, ovaries and part of the
vagina are removed.
At Hoag, radical cystectomy is performed using robotic surgery, which allows
for greater precision and potentially quicker recovery.
Following a radical cystectomy, the surgeon will create a new method for
the patient to expel urine. Multiple options exist, and the decision is
based on what is best for the particular patient-both physically and preferentially.
The surgeon can create a tube, or urinary conduit, with a piece of the
intestine that runs from the ureters to the exterior of the body. The
urine then empties into a urostomy bag worn on the abdomen.
Another option is for the surgeon to create a small reservoir inside the
body-called a cutaneous continent urinary diversion-to contain urine.
The urine is drained from the reservoir via a hole in the abdomen a few
times per day through a catheter.
In certain cases, the surgeon can create a reservoir that functions more
like the bladder out of part of the intestine, which is called a neobladder.
Attached to the urethra inside the body, this allows the patient to urinate normally.
How can I get a second opinion?
A bladder cancer diagnosis can be scary and overwhelming. It is important
that you have all of the information you need and an expert medical team
to assist you in this journey.
If you would like a second opinion, Hoag can assist in connecting you with
the proper resources.
Contact Us 949-7-CANCER (949-722-6237) to learn more.