Deep or Muscle Invasive Bladder Cancer
 
A quarter of patients will have this disease at the time of diagnosis and about a tenth of those with superficial bladder cancer will develop it eventually. Invasive disease has been classically treated by removal of the bladder or cystectomy. Cystectomy is considered by most studies done so far to best option for aggressive bladder cancers. The operation of cystectomy is extensive and removes most of the adjacent organs in the pelvis, but this is done to keep the risk of cancer recurrence as low as possible. Chemotherapy may be needed either before or after surgery.

Patients who have their bladder removed will have some reconstruction to allow urine to be removed from the body. Surgeons may be able to create a pouch that can act as a bladder and/or create a urostomy (an opening in the abdominal wall to carry urine to a bag outside the body).

RPCI also offers robot-assisted surgery, a type of minimally invasive surgery (MIS) to remove the bladder. The da Vinci® Surgical Robotic System has been used by our surgeons since August 2004. Robot assisted radical cystectomy has been offered since October 2005. Advantages include less pain (more than 50% decrease in pain compared to open operation), quick recovery, less blood loss and fewer complications.

 Bladder preservation is an option to be considered by the treating urologic surgeon after review of the pathology, location and the overall clinical picture. Higher stages need radical approaches. Biomarkers like p53, p21, Rb etc may also assist in the decision. In T3 and T4 tumors, due to extravesical and nodal disease, sometimes even the radical approach fails to have a satisfactory outcome.