Hi. I'm Dr. Mark Tyson,
a urologist at Mayo Clinic,
and I'm here to answer some of
the important questions you might
have about bladder cancer.
The type of bladder cancer
that most patients are
diagnosed with is urothelial carcinoma.
There are other types of
cancers of the bladder,
like adenocarcinomas
and small cell carcinomas,
but urothelial carcinoma is the most common.
Some urothelial carcinomas
have what's called variant histology,
and these can be plasmacytoid,
micropapillary, microcystic.
These are tumors that generally
increase the aggressiveness
of the urothelial carcinoma.
But in addition to the cell type,
you'd also need to know
the grade and the stage of your tumor.
These tumors are generally
graded as low grade and high grade,
with high-grade cancers
being more aggressive.
The grade, the stage,
and the type of cancer are all
used to determine the type
of treatment that you will receive.
The treatment options depend on
the grade and stage of your tumor.
If you have a high-grade,
non-muscle-invasive bladder cancer,
we generally treat that with
a transurethral resection
of the bladder tumor,
followed by intravesicle therapy,
either with chemotherapy
or immunotherapy, like BCG.
If you have an invasive carcinoma,
such as a muscle-invasive cancer,
we generally treat that with upfront
cisplatin-based combination
chemotherapy, followed
by removal of the bladder or radiation.
There are quality of life and toxicity
considerations with each of those options,
and it's up to the individual to
decide which is right for them.
Adjuvant immunotherapy is a type
of treatment that's given after
surgery to help mitigate the risk
of cancer recurrence down the road.
Patients who have stage 4 bladder cancer
are generally treated with
first-line cisplatin-based
combination chemotherapy.
The short answer is, it
really doesn't matter. Whether you had
the surgery done open or
whether you have it done robotically,
the outcomes are about the same.
This is a big operation
and patients are going to be in
the hospital for a few days after
surgery and require a few weeks to recover,
no matter how the surgery is done.
With a robotic approach, though, there
are tiny laparoscopic incisions.
And in general,
there's a little bit less blood loss
and perhaps a few fewer wound complications.
With the open approach, the surgery is faster,
but associated with a little
bit more blood loss.
And I encourage patients to go with
the surgery that feels right for themselves.
A neobladder is a type
of urinary diversion that's
performed during the surgery
to remove the bladder.
So when we remove the bladder,
we have to reroute the urine somewhere.
And what we do is we take about
a foot of small intestines, called ileum,
and we detubularize it, or fillet it, open.
We create it into a sphere.
And then we connect that down to
the urethra and then we connect
the kidneys into that.
And it's nice because all of the hardware,
so to speak, is on the inside of the body.
There's no external drainage bag
for urine, like there
is with an ileal conduit.
But there are some downsides to a neobladder.
They don't work perfectly.
For example, about 25% of
men will have some degree
of long-term incontinence,
and about 30% of women.
About 10% of men will need to
catheterize to empty their neobladder
and about 25% of women will, as well.
And these are
important considerations as one is
deciding between a neobladder and a conduit.
An ileal conduit is a form of
urinary diversion where there's
an external bag used for drainage.
Unlike a neobladder where
we build a new bladder and connect
the kidneys to the urethra and
everything's on the inside of the body,
an ileal conduit diverts
the urine outside of the body.
So just to the right
of your belly button there'll be
a stoma, like an ostomy,
that drains into a bag.
For lots of patients,
this is the best option.
It's simple and it's
easy to learn how to use.
There's no getting up at
night to use the restroom.
There's no stopping when you're driving.
And anything that you were doing
before surgery, you can do after.
This includes scuba diving, skydiving,
water skiing, golfing, hiking, biking.
Lots of patients ask
the question of what's
the right diversion for me?
And it just really
depends upon the individual.
For individuals who are
looking for simplicity,
the ileal conduit is the right choice.
Quality of life is
a very important consideration when
deciding what treatment options
are best for you.
For non-muscle-invasive bladder cancer,
we generally treat with
intravesicle therapy.
But there are side effects of treatment:
Burning pain with urination,
frequency, urgency, blood in the urine.
They also involve catheterizations
and can be painful during
administrations. For patients who
have muscle-invasive disease,
and they're trying to decide between whether
to do a cystectomy,
which is complete removal of
the bladder, or radiation therapy,
there are a number of quality of life
implications there as well.
Patients who are invested in
their care are the easiest to take care of.
Learn as much as you can.
And remember, we're all on the same team.
Never hesitate to ask
your medical team any questions
or concerns you have.
Being informed makes all the difference.
Thanks for your time and we wish you well.