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>> In women, just like in men,
bladder cancer is most
commonly detected through presence of blood in the urine.
Sometimes there are also some irritative urinary symptoms that can
present and give a clue
to presence of any cancer in the urinary tract.
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>> For women just like for men,
there are common risk factors for bladder cancer.
History of smoking or current smoking is one of them,
exposure to certain chemicals,
exposure to recurrent irritants
to urinary system such as stones infections.
Those are all the common factors.
Some things that are unique to women,
they do present less frequently than
men with bladder cancer in proportion 3-1.
But when they do present,
it's usually with more advanced stages of bladder cancer.
Whether that is exposure to
environmental irritants or our failures clinicians
to diagnose them early enough,
or presence of the estrogen in their body,
that is to be studied and found.
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>> Bladder cancer presents with a variety
of stages and grades
and they're all treat a little bit differently.
For high grade muscle-invasive bladder cancer,
a lot of the times we pursue radical surgery,
sometimes we can try to preserve
the bladder and do something that's called trimodality
therapy with resection of
the tumor but leaving the bladder in place,
chemotherapy, and radiation.
More standard treatment for
muscle-invasive cancer is removal of the bladder,
as we will discuss,
and possibly some of the adjacent organs and lymph nodes.
The recover from that is very
different than the rest of the surgeries.
Now majority of the bladder cancer actually
presents a non-muscle invasive stage,
so superficial invasive or non-invasive,
and that one is treated differently.
For that, we would do a biopsy or a resection of the tumor,
and we would give intro vesicle treatment,
whether it's with a chemotherapy,
immunotherapy, and sometimes systemic immunotherapy as well.
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>> Radical cystectomy for women in the past has
involved the removal of majority of the pelvic organs.
That is removal of the bladder,
pelvic lymph nodes, uterus,
ovaries, fallopian tubes, and anterior wall of the vagina.
We are starting to move away from
this radical surgery and concentrate more on the bladder removal.
Because with the newer advances in science,
we know that bladder cancer rarely affects the ovaries,
rarely affects the uterus.
Sometimes can involve the anterior vaginal wall
but not all the time.
We are moving more towards the organ preservation of women.
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>> Organ preservation in women has numerous benefits.
By leaving the ovaries behind,
we do less disturbance to the hormonal milieu of the body,
and that has some end-organ effects that are beneficial.
By removing less organs,
we maintain a pelvic support and integrity of the pelvic nerves.
All of these can translate into
a better support of the organs in a pelvis,
a better sexual function outcomes after the surgery.
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>> Urothelial cells lie in
more than just the bladder in the human body.
They lie in the upper tracks that lead to the kidneys and also the
small tube called urethra
that connects the bladder to the outside world.
Urethrectomy is very commonly performed in women,
and not as commonly performed in men.
Not really for any biological factors,
but more as a dogmatic way to do the surgery.
We had removed the urethra in the past thinking that it would
minimize the risk of bladder cancer recurrence
and remove the remnant urothelium.
We're learning now that that is not always necessary.
We know that removing the urethra sometimes damages
the pelvic nerves in women
and decreases the collateral sensitivity lubrication,
so there is a need to preserve the urethra when it's possible.
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>> Recovery from radical suspect enemies is a pretty big process,
just because the surgery is
a highly morbid surgery, it requires hospitalization.
Usually, patients spend about 4-5 days in the hospital.
They come out of the surgery with a variety
of different drains in tubes.
The leaving from the hospital and
the discharge are usually contingent
on recovery of bowel function,
good pain control, ability to manage
one's drains when the patient leaves the hospital.
Within a month or two,
patients are able to resume their normal activities.
The other aspects of recovery from
radical cystectomy may involve physical therapy,
whether it's outpatient or rehabilitation,
some are occupational therapy,
and again, step-wise removal of
the tubes and resumption of normal urinary activity.
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>> Bladder cancer, as we know,
is one of the diseases that is
managed the best with a multidisciplinary team support.
We have a team of urologists,
multiple medical oncologists, physical therapists,
pelvic floor therapists, nutritionists,
urogynecologists that when come together,
provide the best support and recovery from bladder surgery.
We do have educational series that are targeted
women that happen multiple times a year.
Additionally, we have monthly support groups
for women only with bladder cancer.
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>> But what makes the women's bladder cancer program
here unique is first and foremost,
the recognition that for
women with bladder cancer have unique needs,
and a collection of individual who have the common goal to
make these needs met and make the recovery easier for women.
We have clinical trials,
we have the support groups,
we have the whole multidisciplinary approach to women that is
aimed to improve both the treatment
and recovery from this disease.
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