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    Understanding Bladder Cancer -- Diagnosis and Treatment

    What Are the Stages of Bladder Cancer continued...

    Stage IV. The cancer has spread outside the bladder to surrounding lymph nodes or organs.

    Recurrent Bladder Cancer. This means that the cancer has come back after treatment.

    If diagnosed early, superficial tumors can usually be treated successfully by transurethral resection (TUR). In this procedure, the surgeon inserts a small tube into the bladder through the urethra and removes the tumor surgically or burns it out with heat or a laser. Using this approach, the abdomen isn't cut. The side effects are usually mild and short-lived and include bleeding and mild pain. You'll be able to go home within a day of the procedure.

    Immunotherapy with the Bacillus Calmette-Guerin (BCG) vaccine is beneficial in 60% of superficial bladder cancers cases. Injecting BCG into the bladder after the tumor has been removed significantly reduces the chance of cancer recurrence. Immunotherapy is a form of treatment whereby the body's own natural defenses (the immune system) are revved up to attack the cancer. BCG is often placed directly into the bladder via a catheter.

    Invasive bladder cancer (it has spread beyond the inner lining of the bladder) may require radical cystectomy, or bladder removal. If a cystectomy is performed, the surgeon will divert the urinary tract and create an opening, or stoma, through which urine is passed. Patients once had to wear external urine pouches, but new techniques synthesize internal pouches from intestinal tissue. Bladder removal may also mean removing the reproductive organs in women and the prostate and seminal vesicles in men. Although this procedure often renders men impotent, injections or penile implants can help. Women will become infertile, but can remain sexually active. Many patients will undergo chemotherapy prior to surgery in an attempt to shrink the tumor and make surgery easier. This technique may also be used to make inoperable tumors shrink down enough to allow surgery to be feasible.

    When only part of the bladder is removed, it's called a partial cystectomy.

    After surgery for bladder cancer, chemotherapy (known as adjuvant therapy) may be necessary to deter recurrence of the cancer. Anyone who has had bladder cancer should have regular follow-up tests, including cystoscopy, because tumors often recur. If the cancer has metastasized, or spread beyond the urinary tract, surgery is not usually considered. Chemotherapy is the primary treatment for recurrent and metastatic cancer.

    Your treatment may involve a combination of radiation therapy and chemotherapy that could spare the need for surgery. This is called "bladder sparing" or selective bladder preservation. In this technique, radiation, or a combination of chemotherapy and radiation, is given after the bladder tumor is removed. After treatment is completed, a follow-up cystoscopy is performed. If the cancer is no longer evident, further radiation with chemotherapy, or chemotherapy alone, is given. However, if the cancer persists (as it does in 40% of cases), the patient then will require a cystectomy or partial cystectomy.

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