Palliative Surgeries Palliative Surgeries Any surgery for metastatic bladder cancer can work as palliative care .e60dc2a1-f33c-4a05-9b50-8e3e8e59762983212687-8d2c-49bc-9285-32164a6e99ca In palliative care, surgery aims to improve your quality of life by decreasing uncomfortable or painful symptoms, says Yerram.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296caf6c76-f460-4174-ba74-b7c4dfecd140 For example, a radical cystectomy can reduce pain while passing urine and blood in the urine that don’t respond to other treatments. It may also help prevent fistulas — openings and passages that form where they shouldn’t, such as between the bladder and vagina.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292f021f46-92a6-4126-9d98-8e44ea826672e60dc2a1-f33c-4a05-9b50-8e3e8e5976295abebb17-9ee0-4542-9306-c31276d73b38 As a palliative option, urinary diversion procedures can ease urine backups and blockages, preventing kidney damage and infections, says Yerram.e60dc2a1-f33c-4a05-9b50-8e3e8e59762970e11ee2-9a06-455f-8b5c-772cf4a61382
Cytoreductive Surgery Cytoreductive Surgery Cytoreductive surgery means removing tumors and tissues nearby.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294295a959-27db-4251-92ac-7027e83f0a76 In metastatic bladder cancer, this often involves removing the main tumor in your bladder, says Yerram. But cytoreductive surgery can also include removing the bladder and areas to which the cancer has spread, also known as metastasectomy. A cancer care team removes these metastatic cancers either by radiation therapy or surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e59762987db126f-955e-4aaf-9fd1-c6be8dbe6e23e60dc2a1-f33c-4a05-9b50-8e3e8e5976291797ee19-ef33-4271-813a-cb77e9702dd6 “[This surgery] is typically considered for patients who have responded well to systemic chemotherapy ,” says Yerram. To take out tumors from the bladder, surgeons can use a procedure called a transurethral resection of bladder tumor (TURBT). A surgeon performs this by inserting instruments through the urethra without incisions in the skin.e60dc2a1-f33c-4a05-9b50-8e3e8e59762966f135e2-a86d-4e3c-9ca2-6541aa3f19a0 For tumors in other parts of the body, you may need a different type of surgery. For example, if you have tumors in the lining around your abdominal organs, your surgeon would need to make a long cut across the middle of the abdomen to take out the tumors and surrounding tissue.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294295a959-27db-4251-92ac-7027e83f0a76 The removal of your bladder tumor can help you live longer and make other treatments like chemotherapy more effective, says Yerram. “Surgery [also] allows for a direct examination of the tumor tissue, providing a more accurate assessment of how well chemotherapy has worked compared to imaging alone.” Even after a TURBT procedure, your cancer may return, and people often need to undergo the procedure again in the future. If you need several TURBT surgeries, scarring on your bladder can make it hard to hold urine for long periods, potentially leading to a need to pass urine more often or urinary incontinence.e60dc2a1-f33c-4a05-9b50-8e3e8e59762966f135e2-a86d-4e3c-9ca2-6541aa3f19a0 After surgery that involves incisions, complications can include the following:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e460d4c4-00df-4ecd-87b9-fc6e14dff7b0 Bleeding Wound infection Blood clots Rare reactions to anesthesia But once your procedure is over, your care team will tell you what side effects to watch for and what to expect as you recover.
Surgery hasn’t always been an option for metastatic bladder cancer (or bladder cancer that’s spread from its original site). But according to limited research, surgical treatments may now help some people with this type of cancer live longer and have a better quality of life.e60dc2a1-f33c-4a05-9b50-8e3e8e597629de00c471-8d31-4f44-919a-d11ab649e3a5 For metastatic bladder cancer, surgery can help control symptoms such as pain, bleeding, or urinary obstruction, says Nitin Yerram, MD , a urologic oncologist and the codirector of urologic oncology at Hackensack Meridian John Theurer Cancer Center in New Jersey. Your surgical options vary depending on your cancer type, location, and stage, but you don’t have to choose one alone.e60dc2a1-f33c-4a05-9b50-8e3e8e597629143227ff-bc40-4fad-b667-0ff39e99e5f6 “The decision to pursue surgery is highly individualized and made by a multidisciplinary team,” says Dr. Yerram. Below, learn the types of surgery used to treat metastatic bladder cancer.
Is Surgery Right for You? Decision-Making You don’t have to decide on surgery for metastatic bladder cancer by yourself. “Your medical team can help you understand all your options,” advises Yerram. “The decision about whether surgery is the right next step for you is not a simple yes or no — it’s a highly personalized choice that depends on many factors.” Yerram says that your care team will check factors like the following before considering surgeries for metastatic bladder cancer:e60dc2a1-f33c-4a05-9b50-8e3e8e5976290c22c103-0a9f-42d8-a1d6-92ce845f7806 Your overall health The location and number of metastatic tumors Your response to other treatments You may meet with a few doctors together, like a surgeon, a radiation oncologist , and a medical oncologist. These providers can work as a team to recommend the best treatment options.e60dc2a1-f33c-4a05-9b50-8e3e8e59762997cee97a-f9b9-45c2-b0aa-b0f0b7ce70c5 Always ask if you could be eligible for any clinical trials. These are research studies that test new treatments or new ways of using existing treatments, says Yerram. “For metastatic bladder cancer, there is a great deal of research into new drug combinations, immunotherapies, and the optimal timing of surgery.” Participating in a trial could give you access to a cutting-edge therapy that a healthcare provider may not offer you otherwise, says Yerram.
Resources We Trust Mayo Clinic: Bladder Cancer: Diagnosis and TreatmentCleveland Clinic: CystectomyAmerican Cancer Society: Bladder Cancer SurgeryMemorial Sloan Kettering Cancer Center: Bladder Cancer Surgery, Cystectomy, Preservation & DiversionNational Institute of Diabetes and Digestive and Kidney Diseases: Urinary Diversion
Metastasectomy Metastasectomy A metastasectomy involves the surgical removal of one or more metastatic tumors from other parts of your body, like the lungs or lymph nodes, says Yerram. The goal of this type of surgery is to take out any tumors growing separately from the main bladder tumor. “In patients with a limited number of metastases (oligometastatic disease), removing these tumors may improve survival, especially if they have responded well to chemotherapy,” says Yerram.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294ce15152-9a85-474a-befc-298b4aa28b1c This surgery also offers a potential cure in rare cases, Yerram adds. “Particularly with solitary lung metastases, complete surgical removal has led to long-term disease-free survival.” And one study review also found a connection between the removal of brain metastases from bladder cancer and longer survival time.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290156761a-b6b4-4a62-a860-664774ec53e7 Another benefit of metastasectomy is pain relief, says Yerram. For example, if a tumor is growing in your lungs, you may have a chronic cough and pain with coughing. But taking it out can improve those symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e59762921481105-eb94-401d-9a2a-21c7ad54cb1d Apart from typical surgical risks, like infection, bleeding, and rare anesthesia reactions, a metastasectomy can cause the following complications depending on the surgical site:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a534a4e4-2bc2-40ab-950b-3aafbb065595 Pneumonia Breathing problems Heart attack Kidney failure Sexual dysfunction may also result, such as the following: A reduced ability for men to achieve and maintain erections Increased discomfort during sex after the removal of part of the vagina in women A negative impact on a woman’s ability to have an orgasm due to damage in the nerve bundles along each side of the vagina Reduced blood supply to the clitoris if a surgeon removes the end of the urethra, possibly affecting sexual arousal But newer surgical techniques can reduce the impact of the procedure on penile erections, and reconstructive surgeries are available to rebuild the vagina. Some surgeries can also spare the nerves linked to female orgasms. Discuss the available options with your cancer care team.
The Takeaway Surgery for metastatic bladder cancer can support other treatments, improve survival time, and lessen symptoms like painful urination or blood in your urine. Metastatic bladder cancer surgical treatment options include bladder and lymph node removal (radical cystectomy), the removal of other tumors in the body, and procedures to rebuild a way for your urine to leave your body (urinary diversion). To work out whether surgery is right for you, you can ask your doctor, who may meet with other specialists to help you decide on the best surgical treatment path.
Radical Cystectomy and Urinary Diversion Radical Cystectomy and Urinary Diversion A radical cystectomy is the removal of the entire bladder and any close lymph nodes. A healthcare provider may recommend it for cancers that have grown large or spread to several parts of the bladder. For men, this procedure means taking out the prostate and the tubes that carry semen. And for women, a surgeon also removes the ovaries, fallopian tubes, uterus, cervix, and some of the vagina.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292c48e3f4-c66e-4163-a349-da92a0b4cd33 Because this surgery involves the removal of your bladder, your surgeon will need to create a new way for urine to leave your body, known as urinary diversion, says Yerram. This may involve the use of one of several different techniques.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299f5c0bb2-da1d-41ce-89a2-712a5035d050 Nephrostomy This is a tube that drains urine from your kidney through a hole in your back into a collection bag. Urostomy This involves a surgeon creating a passage for urine using a piece of your intestine or by bringing the ureters, the tubes that carry urine from the kidneys to the bladder, out through the skin to drain into a bag. Bladder Substitute A surgeon creates a replacement bladder from a piece of your intestine, allowing you to hold your urine and go to the bathroom when needed. A radical cystectomy can increase survival time and remove the main source of your tumor, says Yerram. “The removal and examination of the bladder and nearby lymph nodes [also] provide crucial information about the extent of the cancer, which can help guide further treatment.” Like any surgery, a cystectomy comes with the risk of bleeding, blood clots , and infection. But complications after a radical cystectomy can also include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976292c48e3f4-c66e-4163-a349-da92a0b4cd33 Nearby organ damage Erectile dysfunction Vaginal discomfort during sex Sexual arousal difficulty