Get help: Invasive bladder cancer
Invasive bladder cancer (sometimes called muscle invasive bladder cancer) is when the cancer has spread into the muscle of your bladder or possibly even further, into adjacent organs.
While this is the more serious of the two basic types of bladder cancer, there are two forms of treatment that can be very successful. These are radiotherapy or bladder removal surgery.
Current knowledge is that both give an equal chance of survival for invasive bladder cancer, so, if both types of treatment are suitable to you, it will be a personal decision which one you choose. As always, do talk about the alternatives with your medical team.
Having your bladder removed (a radical cystectomy)
Radical cystectomy (RC) is the removal of your bladder together with the nearby lymph nodes, part of the urethra, the prostate (in men), and the cervix and womb (in women). It is a major operation, lasting at least 6 hours, but gives a good chance removing the cancer permanently. Recently, some RCs have been carried out using robotic surgery, but currently there is limited evidence whether this is better than the traditional surgeon’s method. Be prepared to feel quite weak immediately after the operation, but remember you will likely be able to go home within a week or 10 days.
Having an RC carries the obvious disadvantage of the loss of normal bladder function. To compensate for this, the surgery will include a way to create an alternative method for your wee to leave your body. This is called a urinary diversion and there are three main types that you might have the opportunity to choose between:
- a urostomy
- bladder reconstruction
- continent urinary diversion
Urostomy (ileal conduit or stoma)
A urostomy is the most common type of urinary diversion and has the longest medical history. Most people who have this call it a stoma, so we'll use that name here. During your operation the surgeon will make a hole in your abdomen. A small section of your small bowel will then be removed and connected to your ureters (the tubes that carry the wee from your kidneys to your bladder). The other end of this section of bowel is then connected to the hole in your abdomen, which will then allow your wee to pass out of your body through this newly formed stoma.
Your wee will then naturally flow out of this stoma to be collected in what is called a stoma bag or urostomy bag (pouch), which you can empty whenever it fills up. People tend to find that they need to empty their stoma bag as frequently as they would normally need to wee. At night, you will connect your stoma bag to a ‘night bag’ that can hold a lot more urine, so you won't have to get up in the middle of the night to go to the toilet.
You will be given plenty of advice from a specialist stoma nurse, who will help you select the type of bag that is most suitable for you. These bags need to be replaced on a regular basis, but all the supplies you need will be delivered to you as you require them.
It will feel very strange having a stoma bag stuck to your stomach all the time, and it will take a bit of time to get used to it, but life will soon get back to normal.
Bladder reconstruction (neobladder)
In some cases it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sack, before connecting it to your urethra at one end and your ureters at the other end. Bladder reconstruction is not a suitable treatment for everyone, but your surgeon might be able to offer this as a choice.
After the operation you will be taught how to empty your neobladder by relaxing the muscles in your pelvis while at the same time tightening the muscles of your abdomen. This sounds very complicated but it won’t take you long to master it. Your neobladder will not contain the same type of nerve endings as a bladder, so you will not get the distinctive sensation that tells you that you need to wee. Some people experience a feeling of fullness, while others report that they feel like they need to pass wind! Your body will find a way of telling you when it’s time to wee.
Due to the loss of nerve function, around 25% of people with a neobladder will experience some episodes of incontinence in the early stages after their operation, which usually occur during the night while they're asleep. You might find it useful to empty your neobladder at set times during the day, including just before you go to bed, as this can help prevent incontinence. Be prepared to wear incontinence pants for a while until you get better control over your new bladder.
Continent urinary diversion
A continent urinary diversion is similar to a urostomy but it does not involve using an external stoma bag. Instead, a section of your bowel will be used to create an internal pouch that is used to store urine. This is quite rare in the UK, with less than 5% of people treated using this method.
The pouch is connected to the urethers at one end and to a stoma in your abdominal wall at the other end. The pouch is then emptied by inserting a catheter (a thin, flexible tube) into the stoma to drain away the urine. Most people empty their pouch four or five times a day.
We have written a guide to living with either a stoma or neobladder that can be found on our Downloads page and at the bottom of this section.
Sexual problems after surgery
For both men and women, an RC can have an effect on your sex life.
After an RC, men this will probably experience some erectile dysfunction, when you lose the ability to obtain or maintain an erection. If this happens to you, contact your GP who will usually refer you to a specialist clinic for treatment. Don’t be embarrassed, sex is a vital part of a healthy life and they have a range of treatments to help you and get your sex life back on track. Treatments range from tablets like Viagra or Cialis through to injections into the side of your penis (this sounds like torture but in reality it is quick and painless and gives you a long-lasting full erection). There are all sorts of treatments, it is just a case of finding which one is best for you.
For women the main effect of this surgery can be the narrowing and shortening of the vagina which can make having sex painful or difficult. There are two main treatment options. First there is a hormonal cream to help increase moisture inside your vagina and make sex easier. The second is to use a vaginal dilator, which is a tampon-shaped device made out of plastic that is designed to make your vagina more supple. Your specialist nurse will be able to provide you with more information or advice. Again, don’t be shy about talking about the issues you may be experiencing. Your medical specialists are experts in this field and won’t be embarrassed in the slightest.
We have specialist nurse advisors here at FBC who can give you confidential advice on any sexual problems or worries. Do email us if we can help.
Radiotherapy is the other treatment option for invasive bladder cancer. It uses pulses of radiation to destroy cancerous cells. There are three main ways that radiotherapy can be used to treat bladder cancer.
- as a primary treatment to try and cure your bladder cancer; this may be the preferred option if your general health is too poor to withstand the effects of an RC
- to help control the symptoms in cases of incurable bladder cancer as a palliative treatment
Sessions of radiotherapy for bladder cancer are usually given on a daily basis for 5 days a week for 4 – 7 weeks. Each session will last for around 10 to 15 minutes. As well as destroying the cancer cells, radiotherapy can also damage healthy cells, which means it can cause a number of different side effects. These include:
- inflammation of the bladder, causing pain when weeing as well as an increased need to wee
- tightening of the vagina in women and erectile dysfunction in men
- loss of pubic hair
With the exception of infertility, these side effects should pass a few weeks after you finish treatment.
Sexual problems after radiotherapy
Radiotherapy for bladder cancer can sometimes cause problems with sex for both men and women.
Some men find that they have problems getting an erection afterwards, or they may find that their erections are not as strong as they were before treatment. Women can suffer from vaginal dryness, but this can normally be helped with gels and creams. Some women may also have a shortening or narrowing of the vagina. Using vaginal dilators or having regular sex can help.
Advice for both men and women can be obtained from your specialist nurse.
SURGERY OR RADIOTHERAPY?
Your team will recommend a treatment based on your circumstances. It is important that they explain all the options, so you can choose based on effectiveness and quality-of-life.
Chemotherapy with invasive bladder cancer
There are three main ways that chemotherapy can be used in the treatment of invasive bladder cancer:
- before radiotherapy and surgery to shrink the size of any tumours
- in combination with radiotherapy before surgery (called chemoradiation)
- to slow the spread of incurable bladder cancer
If you are treated with chemotherapy, a specific combination of different chemotherapy medications will be injected into your veins. This treatment varies according to your specific needs, but is often given to you on a number of days over a 28-day period, which can be repeated according to what treatment path you're on.
The side effects of having the chemotherapy injected directly into you can include:
- feeling sick
- being sick
- losing your hair
- not feeling hungry
- feeling tired
These side effects should stop after your treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infections. If you do get any symptoms of an infection such as a high temperature, persistent cough or reddening of the skin, make sure you see your doctor immediately.
Living and surviving invasive bladder cancer
Whatever treatment you have for invasive bladder cancer, there is still a chance that the cancerous cells could return elsewhere in your body, such as your lungs, abdomen and pelvis. Because of this you will be asked to attend regular appointments where you will be checked by a scan. These usually start as either 3- or 6-monthly checks and are usually reduced to just one a year after three years post treatment.
These follow-ups are important as, if your cancer does return, it will be picked up as soon as possible.
Going back to a normal life after having major surgery or radiotherapy treatment for bladder cancer can seem daunting, but there are many, many people who are living happy lives after treatment.
Do have a look at our Surviving Bladder Cancer page for our best advice on how to cope with emotional issues that a bladder cancer diagnosis is likely to bring.
Don’t forget that we have some great downloadable information to help you.
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We’ve done everything we can to make all the information on this site as accurate as possible. Whilst we have had support from a small team of medical professionals advisors to review the general medical content of this site, please remember, that only YOUR medical team can give YOU specific advice about YOUR symptoms or illness. We encourage you to discuss any potential options with them.