Several surgical approaches are available for advanced bladder cancer, including cystectomy and transurethral resection of the bladder tumor (TURBT). They vary in risk of side effects and recurrence.
Bladder cancer is considered advanced once it has grown outside of the bladder and into the surrounding tissues.
Depending on how far the cancer has spread, oncologists may refer to it as locally advanced or metastatic. Advanced bladder cancer may be categorized as stage 3B or stage 4.
Chemotherapy or immunotherapy is often the primary treatment approach for advanced bladder cancer, but surgery can be used at this stage as well.
Read on to learn answers to the most common questions related to surgery for advanced bladder cancer.
Two types of surgery are used to diagnose and treat bladder cancer:
- transurethral resection of the bladder tumor (TURBT)
- cystectomy
During a TURBT, a surgeon removes the tumor from the bladder lining and muscles using a thin scope inserted via the urethra. General or local anesthesia is used to minimize discomfort.
TURBT can also be used to help doctors see and examine a tumor. It’s important to note that TURBT is not typically used as a
In some cases, doctors use an electrical current or laser to destroy remaining cancer cells after the tumor has been removed. This is known as fulguration.
With advanced bladder cancer, a TURBT is typically done after medications, radiation therapy, or both are used to shrink the tumor. If the tumor cannot be completely removed or killed with additional medication or radiation therapy, doctors may consider a cystectomy.
A cystectomy is a surgical procedure that removes all or part of the bladder. If the whole bladder is removed — known as a radical cystectomy — additional reconstructive surgery is done to allow urine to exit the body through the intestines. Alternatively, doctors can construct a new bladder using pieces of the intestines.
Treatment does not necessarily end after the bladder tumor is removed, especially with advanced bladder cancer. Most people receive additional treatment with medication or radiation therapy. Additional surgeries may be required if the tumor continues to grow.
Additional follow-up testing will likely be recommended even if the tumor is completely removed. Experts estimate that about half of the people will have their bladder cancer return within 12 months of a TURBT, even with additional treatment.
After a TURBT, monitoring for recurrence of bladder cancer may include:
- cystoscopy every 3 months
- imaging of the urinary system and chest every 3 to 6 months
- blood tests every 3 to 6 months
- urine tests every 6 to 12 months
If no cancer is detected after 5 years, more frequent monitoring may not be needed. Continued monitoring can be decided between the person and their doctor based on the person’s specific medical history.
In the event the cancer returns, more medication can be given, a TURBT can be repeated, or a cystectomy may be considered.
Side effects of TURBT surgery are generally mild and short-lived. There may be some bleeding or pain with urination during the first few days after surgery. If fulguration is done during the surgery, you may experience some discomfort in the bladder.
Repeated TURBT surgeries can cause scarring of the bladder, which may cause additional side effects. The bladder may not be able to hold as much urine as it used to, leading to more frequent urination and potential loss of bladder control.
More frequent urination is also a possible side effect of a partial cystectomy since the bladder will be smaller and can’t hold as much urine.
With a radical cystectomy, urine leaves the body through a urostomy or an opening in the abdomen called a stoma. Complications can develop related to this, including:
- infections
- urine leakages or blockage
- incontinence (loss of bladder control)
- pouch stones
Surgeons may also remove tissues from the prostate gland, seminal vesicles, or vagina during a cystectomy, which can lead to sexual side effects, like erectile dysfunction or vaginal dryness. However, surgical options may be available to preserve or restore sexual health if applicable.
Although TURBT surgery can be repeated multiple times to remove tumors that come back, there is no hard rule about how many surgeries can be performed.
In most cases, a TURBT is done at the time of diagnosis to evaluate the spread of cancer within the bladder. In most cases, a repeat TURBT is recommended after initial treatment with medications or radiation therapy to check how the tumor has responded.
Life expectancy in people with advanced bladder cancer varies considerably based on how far the cancer has spread.
If the cancer has spread to nearby lymph nodes but remained relatively localized within the pelvis, the
If the cancer has spread beyond the pelvis to more distant areas of the body, life expectancy drops considerably. The 5-year relative survival rate for people with metastatic bladder cancer is
Research has found that survival outcomes for people with bladder cancer are better after radical cystectomy than after bladder-preserving trimodal therapy consisting of TURBT, chemoradiation therapy, and surveillance.
Even with radical cystectomy, people with advanced bladder cancer have shorter life expectancies than those with more localized tumors. However, studies suggest that surgery may improve survival rates.
According to the National Cancer Institute, the 5-year cancer-specific survival rate for people with tumors that spread beyond the bladder to nearby lymph nodes or organs is
The survival rate for those with metastatic bladder cancer (cancer that has spread beyond the bladder to distant parts of the body) is
A 2023 study involving 2,047 people with bladder cancer in Finland reported a 5-year cancer-specific survival rate of 47% in those with tumor spread after radical cystectomy. In this population, the 10-year cancer-specific survival was 44%.
Life expectancy with advanced bladder cancer is low, but surgical treatment can improve outcomes.
A variety of surgical approaches are available that vary in their risks for side effects and recurrence. Complications are more likely after cystectomy, but survival outcomes are often better than with TURBT.
If you’re unsure whether TURBT or cystectomy is right for you, your oncologist and surgeon can help you consider your options based on your individual needs and preferences.