Most patients diagnosed with bladder cancer need to have some type of surgery as part of their treatment.1,2 Depending on the stage and grade of the patient’s bladder cancer, different types of surgery may be recommended by healthcare providers. Types of surgery that may be used to treat bladder cancer include:
- Transurethral resection of bladder tumor (TURBT)
- Radical or partial cystectomy
- Lymph node dissection
- Reconstructive surgery
Surgery for non-muscle invasive bladder cancer
Bladder cancer typically starts to grow in the urothelium, which is the thin layer of cells that line the inside of the bladder.2 In patients diagnosed with non-muscle invasive bladder cancer, the cancer cells are only located in the urothelium and have not grown into the muscle of the bladder wall. This type of bladder cancer is often treated with a surgical procedure called transurethral resection of bladder tumor (TURBT). In addition to being a treatment for bladder cancer, the TURBT procedure is also used as part of the process of diagnosing and staging a patient’s cancer.
What is a transurethral resection of bladder tumor (TURBT)?
TURBT is used to remove tumors and surrounding tissue from the bladder lining. The surgeon performs the TURBT procedure using a small thin surgical instrument—called a cystoscope—that is inserted into the bladder through the urethra. The urethra is the thin, hollow, tube-like organ that connects to the bladder and allows urine to pass from the bladder out of the body. The surgeon removes the tumor and surrounding tissue that may be affected by cancer cells using a wire loop, a laser, or high-energy electricity (called fulguration).
Surgery for muscle-invasive bladder cancer
If bladder cancer cells have grown beyond the lining of the bladder and into the muscle layer of the bladder wall, a patient is diagnosed with muscle-invasive bladder cancer.2 Many people with muscle-invasive bladder cancer need to have a type of surgery called cystectomy.
What is a partial or radical cystectomy?
The most common type of cystectomy is a radical cystectomy, in which the surgeon removes the patient’s entire bladder, lymph nodes in the pelvis, and potentially additional tissues and organs. Male patients may have the prostate and seminal vesicles removed; in female patients, surgeons may remove the uterus, ovaries, fallopian tubes, cervix, and part of the vagina. Partial cystectomies, in which only part of the bladder is removed, are less commonly used to treat muscle-invasive bladder cancer.
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 patient’s 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 patient’s bladder cancer, because bladder cancer cells can travel from lymph nodes in the pelvis to other parts of the body through the lymphatic system.
Reconstructive surgery after bladder removal
In patients who have bladder cancer that requires treatment with a radical cystectomy to remove the entire bladder, the surgeon will likely create a new way for the patient’s body to store and pass urine.1 This is called reconstructive surgery or urinary diversion. There are different types of reconstructive surgery following radical cystectomy, and patients work with their cancer care team to decide on the best option available for them.
Types of urinary diversions
Types of reconstructive surgery include:
- Incontinent diversion
- Continent diversion
In all three types of reconstructive surgery following radical cystectomy, the surgeon utilizes a piece of the patient’s intestine to connect to the ureters, which are small tube-like organs that deliver urine from the kidneys to the bladder. In patients with an incontinent diversion, the urine is then stored outside of the body in a pouch connected to an opening in the abdomen called a stoma. In patients with continent diversion, the urine is stored inside of the body in a pouch and then passed through a catheter connected to the stoma several times a day. In patients with a neobladder, urine is stored in a new bladder that is made from part of the intestine, which is attached to the patient’s urethra. This allows patients to potentially urinate in a more normal way after they recover from the surgery.