Bladder Cancer
Bladder cancer is caused by a number of different cell types, however,
more than 98% of bladder cancers are due to one of three cell types:
transitional cell, squamous cell or adenocarcinoma. Transitional cell
tumors account for the vast majority comprising approximately 90% of
all bladder cancers.
There are two degrees of bladder cancer, each of which differs from
the other in prognosis and treatment. The division between the two is
based on whether or not bladder muscle is involved by the cancer. For
those transitional cell cancers, which do not invade the muscle of the
bladder, local therapy is usually successful. However, about 20% of
these cancers will eventually invade the muscle and therefore convert
to the more severe degree. Patients with transitional cell cancers
which involve the bladder muscle require a much more aggressive
approach to treatment.
The treatment of non-muscle invasive cancer at the MGH initially
requires biopsy and then diathermy or laser destruction of the
remaining tumors. This treatment may be followed by installation of
medication directly into the bladder, which is meant to destroy any
residual cancer and prevent recurrences.
The treatment of muscle invasive bladder cancer at the MGH may be
accomplished in two ways. For selected patients, a Bladder
Preservation Protocol is available. This involves non-incisional
resection of the cancer, followed by radiation therapy and
chemotherapy. In the properly selected patient, the disease is
irradicated and the patient retains their bladder so that they are
able to void normally.
The more conventional treatment for this disease is to remove the
bladder. This requires a rerouting of the urine. The simplest method
is to surgically create a conduit from the bowel and collect the urine
in a bag on the abdomen. For selected individuals, a new bladder
(neobladder) may be fashioned from bowel so that the patient does not
need to wear a bag and can void normally. The latter procedure is
performed by the Division of Reconstructive Surgery.
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