Treatment depends on the stage of disease. For superficial tumors that do not invade muscle, resection (cutting out), fulguration (burning out with heat or laser) or intravesical therapy (placing drugs directly into the bladder by a catheter inserted through the urethra) are the treatment options.
Therapy for muscle invasive lesions (Stages B and C) depends on the extent of invasion, the grade of the tumor and how involved the local lymph nodes and the blood vessels of the bladder are.
Surgery Removal of the tumor \can often lead to cure. In selected cases where a single, relatively
low grade tumor is found without carcinoma in situ , removing the tumor along with the adjacent portion of the bladder wall that guarantees an adequate margin (partial cystectomy) is appropriate.
But if the bladder shows evidence of "instability"—a tendency to continuously form new tumors as shown by the repeated presence of carcinoma in situ—a radical cystectomy is the treatment of choice. Radical cystectomy involves removing the entire bladder, the fat and tissue surrounding the bladder (perivesical) and the pelvic lymph nodes. In men, the prostate and seminal vesicles are removed. In women, the uterus , tubes, ovaries, anterior vaginal wall and urethra are removed.
Cystectomy raises many quality-of-life issues, especially concerning its effect on sexual function because of the nerves controlling penile erection being cut and the need for an ileal conduit (a piece of the gut or small bowel) leading to a large plastic bag outside of the body to collect urine.
