UCLA's Team Approach
There are a variety of treatment options available to patients who have been diagnosed with bladder cancer. Here at UCLA, the course of treatment for bladder cancer is individualized to each patient’s cancer grade and stage as well as current state of health. The management of bladder cancer requires extensive collaboration. The Institute of Urologic Oncology at UCLA has a multi-disciplinary team that specializes in treating bladder cancer, and offers a number of innovative options. Bi-weekly conferences are held and attended by specialists including urologists, medical oncologists, radiation oncologists, pathologists, radiologists, and clinical trial nurses. This provides a forum with diverse, specialized perspectives for deciding upon the best option for each individual patient.
Radical cystectomy may be the optimal treatment for bladder cancer for aggressive or recurrent disease. This technically demanding and complex surgery can now be performed using a minimally invasive, robot-assisted laparoscopic technique for many patients. Our early oncologic outcomes, complication rates, and recovery times compare favorably with the traditional open approach. Here are a few vignettes of this surgery.
Initial staging and treatment of bladder cancer is performed by TURBT to determine the depth with which the tumor has invaded the bladder wall and thus the T stage, as well as imaging tests. This may be the only initial treatment for tumors that are superficial (cis, Ta, T1), although sometimes we repeat the operation in several weeks to ensure that the entire tumor is removed. It is often followed by intravesical drug therapy, in which medications are placed into the bladder through a urethral catheter, including Bacillus Calmette-Guerin (BCG treatment for bladder cancer), mitomycin C, and interferon-alpha.
Early-stage bladder cancers can often be cured by the combination of these methods. Tumors that have progressed into the muscle require more extensive treatment. The prognosis of bladder cancer is poorer for these more advanced cancers. The gold standard is complete removal of the bladder, surrounding organs, and regional lymph nodes, a bladder cancer surgery procedure known as a radical cystectomy and bilateral lymph node dissection. Advances in surgical techniques include the use of robotic-assisted, minimally invasive removal of the bladder. The robotic-assisted, minimally invasive cystectomy has the potential for shorter recovery time and decreased blood loss. Some patients will benefit from chemotherapy prior to surgical removal of the bladder.
For select patients a bladder preservation protocol of combining transurethral surgery, radiation therapy, and chemotherapy may be performed. Others may be amenable to a partial cystectomy in which only a portion of the diseased bladder is removed. Once the bladder is removed from the ureters and urethra it is necessary to provide another way to collect and drain the urine. Several options exist and depend on the overall health of the patient, the extent of cancer, and an individual's motivation and active participation in their care.
UCLA is an innovator in the reconstruction of the urinary tract. In selected patients, a portion of the intestines is used to create a new bladder or neo-bladder. The ureters are joined to one end of the neo-bladder and the other end is connected to the remaining portion of the urethra. The new bladder is constructed in such a way that it will provide a reservoir to store urine and control urine flow. People learn to urinate in much the same way they do now. However, at the time of surgery if your urethra is involved with cancer, it will need to be removed and some patients may benefit from creating a continent diversion, where one end of the new bladder will be brought out to the side of the abdomen to create a stoma without the use of an appliance bag. A small catheter is then passed through the stoma to drain out the urine and empty the new bladder 4 to 6 times a day.
These options are the most complex reconstruction requiring a motivated individual and both may require the ability to self-catheterize the bladder. For both neo-bladders and continent diversions, you may need to irrigate your new bladder to remove excess mucus. Since the urinary diversion is constructed from the intestine, the presence of mucus in the urine is normal following this surgery. Some patients are better served by creating a simpler ileal conduit. This is created using a shorter portion of intestine between the ureters to a stoma connected to the side of the abdomen. It acts as a funnel to drain urine from the kidneys to an appliance bag attached to the patient’s skin. It has the disadvantages of requiring an ostomy bag, but it is a shorter and simpler operation with the least chance of post-operative or long-term complications.
New types of bladder cancer treatment are also being tested in Clinical Trials. For a list of current trials, as well as information on inclusion and exclusion criteria, please call our Clinical Trials Office - (310) 206-5930.
Radical cystectomy is a major surgical procedure and often patients with bladder cancer are in an age group with other medical problems. At UCLA, we have an excellent support structure to help patients before, during, and after your surgery. In addition to our surgical team, an internal medicine hospitalist service routinely follows all our bladder cancer patients following surgery and is available to see patients before surgery to get acquainted with some of our more complicated cases. We have well-trained nurses on the ward and intensive care unit, a pain service team headed by anesthesiologists, stoma nurses, social workers, physical therapists, and nutritionists .
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The Department of Urology at UCLA is one of the most progressive and comprehensive urology programs in the country. Our faculty members work side by side with research scientists for new cures and treatments for bladder cancer.