Hospice care is designed to provide care to patients at the end of life. The term originates from the same root as “hospitality,” the idea of providing shelter to a sick or weary traveler. According to the American Cancer Society, “Hospice provides humane and compassionate care for people in the last phases of incurable disease [...]

The most basic credo of modern medicine is “first, do no harm.” Many of the treatments that we now have available, although often lifesaving, can be painful or difficult for patients and their families. We offer these treatments and encourage patients to persist because we truly believe that after all is said and done, the [...]

I have never thought of dying before, but now that I have been diagnosed with bladder cancer, I find myself wondering, are there things that I should do to prepare for death? None of us likes to think about the end of life, particularly while we still feel young and healthy. Many of us are [...]

Most patients become involved in a clinical trial at the invitation of their own physician. Even at the largest centers, any individual physician will be involved in only a small number of trials, which may or may not apply to you. With the advent of the Internet, it has become dramatically easier for patients to [...]

A clinical trial is the process through which new medications or therapies are tested to determine their ability to perform their stated task. They are also used to evaluate surgeries, radiation, and combinations of these treatments. Not all trials lead to success, but many do. There are four phases of clinical trials. Phase I: This [...]

Metastatic bladder cancer is generally quite difficult to treat. Current treatment for bladder cancer that has spread outside of the bladder is aggressive chemotherapy. Most often, a combination of four drugs is given. These medications are abbreviated M-VAC, which stands for methotrexate, vinblastine, Adriamycin (also called doxorubicin), and cisplatin; 60% to 70% of tumors will [...]

Some cancers produce specific substances that can be measured in the blood. Many readers will be familiar with the relationship of PSA to prostate cancer. After surgery for prostate cancer, the blood levels of PSA should decrease to zero. By periodically rechecking the level of PSA in the blood, we can monitor for a recurrence [...]

The spread of any cancer outside of its organ of origin is called a metastasis. Bladder cancer tends to metastasize first to the lymph nodes in the pelvis. This is why the lymph nodes are removed during surgery. Some surgeons feel that removal of these lymph nodes only provides information to doctors and patients about [...]

Whether bladder cancer is superficial or invasive, it must still be confined to the bladder to be treated successfully by surgery. Once the tumor escapes from the bladder, it is difficult or impossible to remove the tumor completely. Like any other cancer, bladder cancer has three different routes by which it can escape the confines [...]

If we know that bladder cancer results from damage to a cell’s genes, can’t we just fix the genes? There has been much excitement in recent years about our growing understanding of genetics and the potential to use “gene therapy” to cure a variety of diseases, including cancer. Although gene therapy is not currently advanced [...]

Bladder-sparing protocols have largely shown similar rates of long-term survival compared with immediate cystectomy. The studies have been criticized, however, as falsely improving their results by selecting only those patients who were already likely to do well. This could mean that there is in fact a survival advantage to having immediate surgery rather than waiting [...]

Bladder-sparing therapy refers to any approach to the management of muscle-invasive bladder cancer in which the goal is to avoid radical cystectomy. There are a variety of approaches, mostly based on the use of chemotherapy and/or radiation combined with transurethral resection of the tumor. In the past, chemotherapy or radiation therapy used without surgery was [...]

A ureteral stent is a long, soft tube that stretches from the kidney to the bladder. You have probably heard about cardiac stents for people who have clogged arteries. These stents hold the arteries open so blood can continue to flow to the heart. Ureteral stents are similar in that they allow the urine to [...]

The immediate surgical risks of a partial cystectomy are similar to the risks for a radical cystectomy. These include bleeding, infection, damage to adjacent organs, and so forth (see Question 39). During a radical cystectomy, the bladder is removed intact. For a partial cystectomy, the bladder is opened, which potentially exposes the body to a [...]

To be eligible for a partial cystectomy, the tumor must be just in the right place and just the right size. Tumors at the dome (top) of the bladder are the most amenable to partial cystectomy. Many patients without cancer develop outpouchings in their bladder called a diverticulum. These outpouchings have no muscle on them, [...]

A partial cystectomy is the removal of only that part of the bladder that has cancer in it. It essentially takes the place of the TURBT in other bladder-sparing protocols. It potentially improves the removal of the tumor over TURBT and gives the pathologist a better ability to identify the tumor and its limits correctly [...]

A continent urinary diversion provides a reservoir for the urine that can be drained every few hours by a catheter inserted by the patient. A segment of bowel is used to create a pouch inside the abdomen into which the urine drains. A small channel is then created that connects the pouch to the abdominal [...]

Long-term problems after an ileal conduit are not uncommon. Overall, up to two thirds of patients will experience some type of problem. These problems can be categorized as follows. Stoma: About one in four patients will have a problem related to their stoma. The most frequent problems are parastomal hernias (a weakening of the tissues [...]

Having a bag on your abdomen will not prevent you from doing the things that you used to do before surgery. The bag is pretty secure when snapped onto the wafer properly. Some individuals who are very active may use a strap or something of that nature to lightly press the bag against the skin [...]

Removal of the entire bladder, radical cystectomy, is the gold standard treatment for invasive bladder cancer. Rarely, individuals may be candidates for less invasive surgery or bladder-sparing regimens. Historically, the primary option to divert the urine after a radical cystectomy was an ileal conduit . Over the years, a variety of continent urinary diversions and [...]