Bladder cancer treatment is dependent on the depth of invasion through the bladder wall. Superficial bladder cancers are treated by resection through the urethra, known as transurethral resection of bladder tumor (TURBT). Under general anesthesia, a scope is inserted into the urethra to navigate the anatomic tube through which the urine exits the body.
For bladder cancer that invades into the muscle of the bladder wall, the gold standard therapy is surgical removal of the entire bladder (radical cystectomy), and dissection of a lymph node to detect whether cancer has spread beyond the bladder. In men, the prostate and seminal vesicles are also removed.
Bladder replacement options are performed with the use of an intestinal segment and are classified as either: (1) incontinent or (2) continent.
An incontinent diversion (ileal conduit) requires a bag to be placed over a stoma to capture urine that drains as it is produced.
A continent diversion stores urine and comes in two types: (1) neobladder or (2) catheterizable pouch that requires insertion of a tube into the diversion to drain urine. Disadvantages of continent diversions include the fact that there may be a greater need to surgically revise the stoma or connections, as these surgical reconstructions are more complex and subject to a higher revision rate, when compared to ileal conduit diversion.
Finally, for patients that have other severe medical conditions that make general anesthesia and/or surgery too risky, bladder sparing radiation therapy may be an option.