Urothelial Cancer

What is Urothelial Cancer?

Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is the most common type of bladder cancer. This means the cancer has started in the urothelial cells lining the inside of the bladder. 

Symptoms

  • Visible blood in the urine (haematuria).
  • Pain during urination (dysuria).
  • Pain in one side of the lower back.
  • Urinary Frequency
  • Feeling like you need to urinate, however are not able to. 

Treatment

Surgery:

The aim of surgery is to remove the tumor and some surrounding healthy tissue. However, there are different types of surgery for bladder cancer. The type of surgery will depend on the stage and grade of the disease. Surgical options may include: 

  • Transurethral bladder tumor resection (TURBT). This procedure is used for diagnosis and staging, as well as treatment. During TURBT. A cystoscope is inserted through the urethra into the bladder. The tumor is then removed using a tool with a small wire loop, a laser, or fulguration (high-energy electricity).

    For individuals that have non-muscle-invasive bladder cancer, TURBT may be able to eliminate the cancer. However, the doctor may recommend additional treatments to lower the risk of the cancer returning, such as intravesical chemotherapy or immunotherapy.  For people with muscle-invasive bladder cancer, additional treatments involving surgery to remove the bladder or, less commonly, radiation therapy are usually recommended.

  • Cystectomy and lymph node dissection. A radical cystectomy is the removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra may also be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. For all patients, lymph nodes in the pelvis are removed. This is called a pelvic lymph node dissection. An extended pelvic lymph node dissection is the most accurate way to find cancer that has spread to the lymph nodes. Rarely, for some specific cancers, it may appropriate to remove only part of the bladder, which is called a partial cystectomy.

    During a laparoscopic or robotic cystectomy, the surgeon makes several small incisions, or cuts, instead of the one larger incision used for traditional surgery. The surgeon then uses telescoping equipment with or without robotic assistance to remove the bladder. The surgeon must make an incision to remove the bladder and surrounding tissue. This type of operation requires a surgeon who is very experienced in minimally invasive surgery. 

  • Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient must wear a bag attached to the stoma to collect and drain urine.

    Increasingly, surgeons can use part of the small or large intestine to make a urinary reservoir, which is a storage pouch that sits inside the body. With these procedures, the patient does not need a urinary bag. For some patients, the surgeon is able to connect the pouch to the urethra, creating what is called a neobladder, so the patient can pass urine out of the body normally. However, the patient may need to insert a catheter if urine does not empty through the neobladder. However, patients with a neobladder will no longer have the urge to urinate and will need to learn to urinate on a consistent schedule.

    For other patients, an internal (inside the abdomen) pouch made of small intestine is created and connected to the skin on the abdomen or umbilicus (belly button) through a small stoma. With this approach, patients do not need to wear a bag. Patients drain the internal pouch multiple times a day by inserting a catheter through the small stoma and immediately removing the catheter.