The James Buchanan Brady Urological Institute
 
 
 
  BLADDER CANCER      
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Surgical, medical and radiation oncology experts at Johns Hopkins work together as a team to coordinate care for bladder cancer patients. They continue ground-breaking research and clinical trials to improve detection and treatment.

Please click here to meet our team.



Treatments

The majority of bladder cancers arise from the lining of the bladder. Over 75 percent of these tumors remain confined to the linin layer and do not invade into the bladder wall.

These tummors are called superficial transitional cell cancers. Advanced bladder cancer is cancer which has invaded into the bladder wall or outside the bladder.

Advanced cancer treatment options are different than those for superficial bladder cancer.

Bladder cancer treatment is determined due to the stage and grade of the tumor(s).


APPOINTMENTS

If you would like to schedule an appointment with us, please call 410-955-6707.

OUR SURGEONS

Trinity J. Bivalacqua, M.D, Ph.D
Christian P. Pavlovich, M.D.
Phillip M. Pierorazio, M.D.
Ashley E. Ross, M.D.,Ph.D.  Stephen M. Schatz, M.D.

Treatment for Superficial Bladder Cancer Can Include:

  • Cystoscopy with cautery destruction of the tumor

    • Most modern cystoscopes are equipped with channels that permit small instruments to be passed into the bladder for the purpose of removing tissue, stopping bleeding with a special electrical device called an electrocautery or even performing laser treatment. If the bladder cancer tumor is small enough this cautery may be used to remove cancer.

  • TUR(Trans-Urethral Resection)

    • This is when the tumor is removed via electrical force from the urinary tract through the urethra. TUR is an endoscopic or scope procedure that does not involve making an incision in the body. The entire removal of the bladder tumor can be accomplished through an operative scope which is passed through the urethra into the bladder.

    • Drug therapy after TUR is commonly prescribed for patients with tumors that are large, multiple or high grade.

  • Intravesical drug therapy /Immunotherapy

    • Here medicines are placed directly into the bladder (intravesical) via a urethral catheter in order to lower the recurrence rate of bladder tumors. This is usually used for multiple CIS large in size (5 cm plus), high grade in stage tumors. About 50-68% of patients with superficial bladder cancer have a very good response to intravesical therapy.

    • Commonly used intravesical drugs are:
      • Mitomycin C which kills the normal DNA function in cancer cells and is easily absorbed into the bloodstream through the bladder's lining
      • Bacille Calmette-Guerin (BCG) forces the immune system to respond to the BCG drug in the lining of the bladder, thus forcing the body's immune system to help fight off the cancer


   Treatment for Advanced Bladder Cancer

  • Partial or radical (complete) cystectomy surgery
    • This is performed when tumors completely invade the bladder's muscular wall

    • Partial bladder removal is rare because the requirements are that all the tumor(s) are easily accessible to be removed, small in size and there are no tumor(s) in the rest of the bladder. This is usually used only if the cancer has not left its' site of origin. Additionally, if all other treatments fail for superficial cancer, this could be used as an alternative.

TYPES OF SURGICAL RECONSTRUCTION TO REPLACE THE REMOVED BLADDER ARE:

  • Ileal conduit

    • This procedure has been routinely performed since the 1950's. The internal pouch which holds the urine is made from a small portion of intestinal tract. One end is closed with sutures while the other end is attached to skin on the front side of the abdomen. A stoma is the open end of the conduit attached to the skin. An external appliance (ostomy bag) covers the stoma to collect urine. The ureters are implanted into the back of the ileal conduit

      .bladder cancer treatment
      Crawford & Das [1990], Current Genitourinary Cancer Surgery, p.271

  • Catheterizable Continent Diversion Pouch
    • This is a reservoir of bowel with a stoma that is catheterizable for emptying the bladder. The urine is siphoned out of the urinary reservoir with a small catheter every 4-6 hours. The catheterizable pouch may require surgical repair at some point after surgery due to the wear and tear of frequent catheterization. This type of reconstruction is not performed on patients with a history of bowel disease.

      bladder cancer treatment
      Benson & Olsson [1998], Campbell's Urology, Chapter 103, p.3231

  • Neobladder

    • A neobladder is a new bladder made of intestines. This internal (new bladder) is connected to the urethra and ureters. After this reconstruction the patient needs to relearn how to void. Some disadvantages of this type of reconstruction are possibility of scar tissue formation at the connection of the urethra and new bladder and incontinence.
      bladder cancer treatment


  • Radiation Therapy

    • The type of radiation which is used to treat cancer is actually a special high energy x-ray that is more powerful than x-rays used for imaging studies. Radiation therapy is planned and executed in a way to kill cancer cells or alter their ability to reproduce while the surrounding healthy cells are minimally effected . Historically, radiation therapy has been used for muscle invasive bladder cancer but current treatment can involve a combined approach of both radiation and chemotherapy. The role of radiation therapy in combination with chemoradiaton therapy (combined chemotherapy and radiation therapy) is to kill the bladder cancer cells both in the bladder and outside the bladder. Local lymph nodes are frequently radiated as part of the therapy to treat the microscopic cancer cells which may be in the nodes.

  • Chemotherapy

    • Chemotherapy is the use of chemical agents that interfere with the replication and other normal functions of cells and results in tumor shrinkage or cancer cell death. The use of two or more chemotherapy drugs together has been found to be more effective than a single drug alone. There are several types of chemotherapy which can be used. The most common chemotherapeutic drug used in bladder cancer is cisplatin.

Comprehensive Medical Care for Bladder Cancer at Johns Hopkins Brady Institute includes Multidisciplinary Care

Multidisciplinary Team

  • Physician experts in bladder cancer
  • Marburg Inpatient Nursing Unit- Nursing expertise in post operative urological care
  • Enterostomal nurse follow-up
  • Social work follow-up/ Cancer Counseling Center
  • Johns Hopkins Comprehensive Cancer Center medical consultation-chemotherapy-radiation




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