Types of Bladder Cancer

Superficial Bladder Tumours
Most bladder cancers are SUPERFICIAL, and look like tiny sea anemones growing on the inside lining of the bladder. They are sometimes known as PAPILLARY tumours; in the past they were sometimes called PAPILLOMAS or BLADDER WARTS. They can be single or multiple.

Treatment of Superficial Tumours

They can be completely removed very simply by cutting them off with a probe passed up the cystoscope and CAUTERISING the bladder wall to prevent bleeding. The tumours are then removed through the cystoscope for microscopic examination. Small tumours are destroyed completely by this treatment but unfortunately the bladder may develop other tumours with time. It is therefore very important to have regular cystoscopies every few months to check that the bladder remains healthy and tumour free. Your urologist will be able to discuss with you how often you will need to come to hospital for cystoscopies once he has looked at your bladder and seen the laboratory result from your biopsies.

Intravesical Chemotherapy
In addition to the cystoscopic removal of the tumour and regular cystoscopies you may be asked to attend hospital as an outpatient to have intravesical chemotherapy. Studies have shown that in some patients the likelihood of developing more tumours may be lessened by washing your bladder out regularly with one of several drugs. This treatment is usually given on a weekly basis for 6-8 weeks.The drug is put into your bladder through a small tube (CATHETER) gently passed into the bladder. The catheter is then removed and you are asked to hold the drug in your bladder for at least I hour, emptying your bladder before leaving the hospital. (It is not a good idea to pass these drugs at home or in a public toilet.)If one drug is not completely successful, other drugs may be effective and will be recommended as the specialist considers appropriate.There are separate information sheets for each drug, and you will be given the appropriate one when your treatment is discussed with you.If the bladder cancer has grown deeper into the bladder wall and extends into the muscle layer or its surrounding tissues it is described as INVASIVE. This happens in only a small percentage of patients by the time it is diagnosed. Very rarely the tumours may have given rise to metastases or secondary deposits elsewhere in the body, as explained in the introduction.For most patients the longer term future will involve regular, but less frequent cystoscopies and occasional admissions to hospital for extra treatment.

Invasive Bladder Cancer

Treatment
Surgery, radiotherapy and chemotherapy can be used alone or in combination to treat invasive bladder cancer. The treatment is planned and discussed with each individual patient, taking into account your age, general health, type and size of tumour and where it has spread, if at all.

Surgery
TRANSURETHRAL RESECTION OF TUMOUR - PARTIAL CYSTECTOMY
If the tumour is confined to the bladder wall, it may be possible to remove the tumour and just the section of the bladder involved. 'This may be done either as a telescopic procedure (cystoscopic RESECTION) or as a cutting operation through the abdomen (PARTIAL CYSTECTOMY). After the operation you will be able to pass urine normally.

Cystectomy
If the tumour is more extensive total removal of the bladder (COMPLETE or RADICAL CYSTECTOMY) may be necessary. In women this involves the removal of the whole bladder, the urethra, the lower end of the ureters, the front wall of the vagina, the womb (HYSTERECTOMY), fallopian tubes and ovaries. In younger women the ovaries may be preserved. As a result the vagina will be shorter and narrower following the operation.

In men the whole of the bladder, the prostate gland, the lower ends of the ureters and sometimes the urethra is removed. It is sometimes impossible to avoid damage to the nerves in the pelvis with the result that men will be unable to achieve an erection, and sexual feeling and orgasm (climax) may be impossible for both male and female patents. In some men inability to obtain and erection can be helped by an injection or an operation.

It can be difficult or embarrassing to discuss sex with the doctors or nurses, but remember, they deal with situations like this every day and are used to discussing personal matters. If you have a partner it may be very helpful for them to see the specialist with you - if possible before the operation is performed.

The operation of cystectomy is obviously very extensive and removes most of tke the structures in the pelvis, but this is done to give the best chance of cure and make the risk of cancer recurrence as low as possible.