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Will I have to have my bladder removed?
The first step in the proper management of bladder cancer is the staging and grading of the tumor. A single transurethral resection of bladder tumor (TURBT) may not be adequate to make a diagnosis. A repeat TURBT of non muscle-invasive disease two to six weeks after initial TURBT can “up-stage” 29% of tumors to reveal the presence of muscle-invasive disease. Repeat TURBTs change disease management up to 33% of the time. Talk to your doctor about the benefits and risks of a restaging procedure.
In general, if your recurrent tumors are low grade, bladder removal is usually not required. Low grade urothelial bladder tumors are similar to some skin cancers in that they recur frequently but are usually not very dangerous. These tumors are usually removed with a cystoscope, and they may not require further treatment, although many patients with recurrent bladder cancer will benefit from intravesical therapy. Still, a small percentage of these tumors may become more advanced in grade, stage, or size, which may make cystectomy necessary.
If you have low grade tumors and then have a high grade tumor recurrence, you can have the growths removed during cystoscopy as before, but your doctor may also recommend that you undergo intravesical treatment.
If you have high-grade Ta, T1, and/or CIS that has recurred after you have already undergone an intravesical therapy, most doctors consider cystectomy (surgical removal of the bladder) the preferred treatment. Waiting to have your bladder taken out could lead to the spread of bladder cancer and even death. You should talk with your doctor about the risks of delaying surgery. Cystectomy is not always an option if you have other significant medical conditions besides bladder cancer that may make you a poor candidate for surgery, or if you are resistant to having your bladder removed.
If you are not a candidate for cystectomy, then repeat intravesical therapy may be considered in place of surgery.
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