Transurethral Surgery for Bladder Cancer
Three-quarters of bladder cancer patients have superficial cancer when they are first diagnosed, and a transurethral resection (TUR) is usually the first treatment they receive. Surgeons perform TUR using a resecting cystoscope, an instrument consisting of a tube with a lens and light, which they insert through the urethra into the bladder. The scope has a wire loop at the end to remove suspicious tissue and tumors. Surgeons may also use lasers and other devices to destroy the base of the tumor (a procedure called fulguration). Since bladder cancer tends to recur, surgeons at Columbia University Department of Urology at NewYork-Presbyterian Hospital follow bladder cancer patients closely and are pioneering numerous new treatments to prevent recurrence and progression. We want to be sure that we catch any future cancers early.
Intravesical Therapies: Immunotherapy for Bladder Cancer
An effective treatment for low-stage, superficial bladder cancer is the immunotherapeutic agent bacille Calmette-Guérin (BCG), which doctors deliver through a catheter directly to the bladder (intravesically). Once in the bladder, BCG appears to stimulate an immune reaction against the tumor cells. BCG prevents recurrence in up to two-thirds of cases of superficial bladder cancer.
Doctors at Columbia Urology are participating in a nationwide trial of another immunotherapeutic approach, gene therapy, for bladder cancer. In patients whose disease has not responded to BCG, doctors infuse a modified virus into the bladder. The virus inserts a gene into the bladder cancer cells for an immune-system hormone called GM-CSF. The infected cells should produce GM-CSF, which in turn may start an immune-system attack on the cancer.
Chemotherapy for Bladder Cancer
Chemotherapy uses drugs to destroy cancer cells and is an important treatment for bladder cancer. It can be delivered directly into the bladder (intravesically) or by injection. Columbia Urology researchers did pioneering and innovative research proving the efficacy of docetaxel (Taxotere) for patients who failed first line intravesical therapy. These patients are often counseled to have their bladders removed, but this treatment may allow many of them to keep their bladders. Columbia Urology researchers are conducting a clinical trial of the effectiveness of the chemotherapeutic agent paclitaxel (Abraxane) when given intravesically.
Cystectomy for Bladder Cancer
For more invasive bladder cancers, surgeons may remove part of the bladder (a partial cystectomy) or the entire bladder and nearby lymph nodes and adjacent organs (a radical or total cystectomy). If possible, we perform cystectomies using minimally invasive robotic laparoscopy (laparoscopic surgery in which surgeons control robotic arms that hold miniaturized surgical instruments through a few small incisions in the abdomen).
Surgeons perform a partial cystectomy when cancer has invaded just one part of the bladder wall and they perform a radical cystectomy when the cancer has spread farther throughout the bladder. In a radical cystectomy surgeons remove the bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells. In men they may also remove the prostate, seminal vesicles, and part of the vas deferens. Women undergoing radical cystectomy may have the cervix, uterus, ovaries, fallopian tubes, and a very small part of the vagina removed.
Reconstructive Bladder Surgery (Neobladder)
If the bladder must be removed, we perform reconstructive surgery to create an alternative way to store and remove urine. Columbia Urology has been at the forefront in reconstructive techniques for patients after radical cystectomy. Surgeons here create a new bladder (neobladder) in appropriate patients from a portion of the small intestine and attach it to the urethra, enabling both men and women to urinate in a more normal manner after bladder removal. Complication rates for neobladder creation at Columbia Urology are among the lowest reported.
If we cannot create a neobladder we create an internal bladder called a continent cutaneous reservoir that is connected to an opening in the abdomen. Patients can drain this reservoir several times a day using a catheter. Another alternative is an ileal conduit, which drains continuously through an external bag.
Radiation Therapy for Bladder Cancer
Radiation therapy for bladder cancer is ineffective when used by itself. When used with systemic (intravenous) chemotherapy and aggressive TUR resection to remove as much tumor as possible, radiation therapy can be use in selected patients to preserve your bladder. During radiation therapy doctors use high-energy rays aimed at the cancer from outside the body. They may also use radiation therapy to shrink the tumor before surgery to make the procedure easier.