Does my high-grade cancer indicate bladder removal?

Question

Hello doctor,

I am a retired plumber and smoked for 38 years. I have been seeing blood in my urine for three months and going to the bathroom 25 to 30 times a day with a burning pain. My urologist performed a cystoscopy and found a four-centimeter tumor in my bladder. The biopsy showed high-grade cancer that has invaded the muscle layer but has not spread yet. My doctor is discussing either removing my entire bladder or trying chemotherapy with radiation to save it.

What is the difference between bladder cancer that has invaded the muscle and bladder cancer that has not?
How serious is my cancer?
What is my survival chance?
Should I have my bladder removed or try to save it?
What are the pros and cons of each option?
If my bladder is removed, how will I pass urine?
What is a urostomy bag versus a neobladder?
Which option is better?
What is the quality of life like with each option?
Do I need chemotherapy either way?
What are the side effects of chemotherapy?
Can the cancer come back even after removing the bladder?
What caused this? Was it smoking or my job with chemical exposure?
Should I get genetic testing?
How often do I need follow-up scans?
What happens if the cancer spreads?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have muscle-invasive bladder cancer, which is serious but treatable. Muscle-invasive bladder cancer means the cancer is deeper and requires aggressive treatment.

I would suggest the following measures:

Radical cystectomy: Curative is the gold standard. You will need a new way to store and pass urine.

A stoma on your abdomen drains urine into an external pouch. The advantages include simpler surgery and fewer complications, while the disadvantage is the need to wear an external bag.
A new bladder is created from your intestine and connected to your urethra, allowing you to urinate normally. The advantage is that there is no external bag, while the disadvantages include a longer surgery, a risk of incontinence or urine retention, and the possibility of needing catheterization.

Trimodal therapy (bladder preservation): This approach uses chemotherapy with radiation to try to save your bladder and allows bladder preservation; however, it has a lower cure rate than surgery, requires close monitoring, and may still require surgery later if the treatment fails.

Chemotherapy is needed in both approaches, either before surgery or with radiation, to kill unseen cancer cells and improve survival.

With proper treatment, five-year survival for localized muscle-invasive bladder cancer is approximately 60 to 70 percent. Cancer can recur locally or spread even after bladder removal, requiring more treatment such as chemotherapy or immunotherapy.

Smoking is the number one cause. Chemical exposure related to plumbing work may have contributed. Lifelong monitoring is required, with scans and checks every three to six months initially.

If it spreads, the focus shifts to controlling the disease with systemic therapies such as immunotherapy and chemotherapy. Discuss both options in detail with your urologic oncologist. Your overall health, lifestyle, and personal preference are key.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.