Actos Bladder Cancer Surgery

Bladder cancer is a disease in which survival depends on vigilance: Symptoms can be difficult to identify, since they are so closely related to warning signs of less serious diseases. Some symptoms include back pain, and bloody or painful urination – classic signs of kidney stones and other, more benign concerns. That’s why Actos (pioglitazone) users must be especially attentive to these factors, since numerous studies have shown that type 2 diabetes medication Actos can cause an increased risk of bladder cancer.

The good news is that survival rates for bladder cancer, the fifth most prevalent type of cancer in the U.S., are high if caught early. For almost all patients – both in early and advanced stages – treatment will include some type of surgery for bladder cancer. Depending on a patient’s condition, surgeons will either remove just the diseased portion of the bladder, or will remove the organ entirely, crafting a new bladder from other body tissues. Bladder cancer surgery saves lives.

The bladder: an introduction

The bladder is a muscular organ shaped like a balloon. In women, the bladder is located between the vagina and uterus; in men, it is situated in front of the prostate. An adult bladder can expand to hold two cups of urine. The bladder is the “last stop” for liquid bodily waste. The organ is connected to the kidneys via two ureters, or tubes; the kidneys filter toxins and other waste into the bladder. From there, the bladder expels urine through the urethra.

The bladder has three main layers: the mucosa (innermost later), the submucosa (middle layer), and the outer layer. Bladder cancer most often begins in the mucosa, but can work its way outwards over time. Because bladder cancer can often go undetected for years, the disease too often has time to mutate and consume the entire organ.

Bladder cancer surgery

Advanced bladder cancer is deadly: In 2012, an estimated 73,000 people were diagnosed with the disease in the United States. That same year, approximately 15,000 Americans died of bladder cancer.

Luckily, the early stages of bladder cancer have much higher survival rates. For about 90% of people diagnosed with bladder cancer, the malignancy has only invaded the innermost part of the bladder (the mucosa). For these patients, surgery for bladder cancer is highly effective, and is not as invasive as for more advanced stages of the disease. Unfortunately, patients suffering from superficial, easier-to-treat bladder cancer are also known to relapse.

For the remaining 10 percent of patients, the bladder surgery procedure is more radical. Surgeons may remove all or part of the bladder, and will check neighboring organs and lymph nodes for signs of cancer.

Depending on the stage and severity of the disease when it is diagnosed, surgeons adopt different methods to treat and remove bladder cancer. These include:

Transurethral Resection of Bladder Tumor (TURBT)

A transurethral bladder resection (TURBT or TBR) is the most common and effective treatment for early stage, non-invasive bladder cancer. During this type of bladder cancer surgery, surgeons use a resectoscope to remove the cancer. A resectoscope is a surgical instrument with a wide-angle telescope, a light, and a wire loop; the instrument is used to identify, burn off, and remove non-invasive tumors and other tissue. Alternatively, surgeons may use a cystoscope, a lighted, hollow tube that allows insertion of other surgical instruments to remove the cancer.

There are several stages to TURBT surgery:

1. Preoperative medications: A week before surgery, patients are required to stop taking aspirin (or drugs containing aspirin), as well as blood thinners (anticoagulants) and nonsteroidal anti-inflammatory medications (NSAIDs).
2. Preoperative procedures: Leading up to surgery, patients must take laxatives and have multiple enemas to clean the bowels. For eight hours prior to surgery, they may only ingest clear liquids.
3. Surgical prep: TURBT bladder cancer surgery is an outpatient procedure, meaning that patients can go home after surgery. Patients are put under general anesthesia or a spinal nerve block; with general anesthesia, the patient is asleep and with the spinal nerve block, the patient is awake (but feels nothing). An additional anesthetic is applied to the obturator nerve (between the pelvis and upper thigh), to prevent the involuntary kicks, reflexes, and other movement during surgery.
4. Surgery: During surgery for bladder cancer, a sterile liquid is used to inflate the bladder so the surgeon can see the organ’s walls. Then, the surgeon will use the resectoscope or cystoscope to view inside the bladder and identify any tumors. As non-invasive tumors are found, the surgeon will burn them off and remove them. As they are removed from the body, they are marked and sent for additional testing. Surrounding tissues are also removed to ensure that all cancer has been eliminated. Some additional tissues may be taken for biopsy. Then, a catheter is inserted to drain all fluids and avoid blockages. TURBT surgery takes about 30 minutes.
5. Post-op procedures: Most patients can go home within a few hours following surgery. If there is heavy bleeding, the catheter will remain in place until the bleeding has subsided. All patients are given a mild pain reliever and antibiotics, and instructed to take it easy for several weeks.

Cystectomy

TURBT surgery is not effective on patients with advanced bladder cancer. Instead, surgeons resort to a cystectomy, an aggressive and major surgery for bladder cancer. A cystectomy may also be used in patients with recurring, non-invasive tumors.

There are two types of cystectomies: partial and radical (full). In a partial cystectomy, only the diseased portion of the bladder is removed. Partial cystectomies are most common in patients with one tumor and normal bladder function.

In a radical cystectomy, the entire bladder and surrounding tissue is removed. For men, this includes removal of the seminal vesicles, vas deferens, prostate and neighboring lymph nodes. In women, this form of bladder cancer surgery means removal of the ovaries, fallopian tubes, affected lymph nodes, and part of the vagina. Radical cystectomies have evolved, and today surgeons are able to reconstruct a bladder, so patients can live a fairly normal life.