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Actos Recall: Despite such a gloomy introduction to this chapter, there is every reason for you to be hopeful if you have been diagnosed with invasive cancer. Current treatment, which includes surgery (cystectomy), chemotherapy, radiation therapy, or a combination of these approaches, offers you an excellent chance for long-term survival and, in many cases, for a cure. This applies particularly to those invasive tumors that have not penetrated outside the bladder, the so-called organ-confined tumors.
There is no question that the after-effects of surgical removal of the bladder (cystectomy) can be unsettling to think about. You won’t have a bladder or maybe even a urethra any longer. How will you be able to pass urine? Will you have to have some type of urine-collecting bag? Will there be an odor? Will it show when you wear certain clothing? Your team will need to surgically create an artificial urine-collection system for you. This is known as a urinary diversion system. In years past, the only option was a urine- collection bag worn outside the body, which many people found to be unpleasant or even embarrassing.
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The good news is that now, in many cases, an artificial bladder (sometimes called a neobladder) can be fashioned from a piece taken from the intestine (bowel), enabling you to void urine in a normal or near-normal fashion. You will have to learn to use a different set of muscles when urinating, and there may be some leakage now and then, particularly at night. Leakage can be controlled by wearing underwear designed with a disposable pad or, for men, a sort of condom. Overall, it’s a more attractive option that makes it easier to face a complicated and often scary surgery such as cystectomy. With modern techniques, most patients no longer have to contend with urinary leakage, except on rare occasions.
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Even if the creation of an internal urinary diversion system is not possible in your situation, keep in mind that there is also no question that cystectomy is a powerful weapon against invasive bladder cancer that can increase your odds of living a long, cancer-free life.
Cystectomy is the most common treatment option for invasive bladder cancer. In most cases, your medical team will recommend a complete (or radical) cystectomy. This means that your bladder, the lymph nodes tucked around your bladder in the abdomen, the prostate in men, and the uterus, ovaries, and part of the vaginal wall in women will be surgically removed. Depending on where the cancer is located, the urethra may also be removed.
It is easy to confuse some of the terms your doctors use, such as “cystoscopy (a diagnostic procedure that introduces a tube into the bladder so the doctor can look at the inner surface and take a biopsy) and cystectomy (the surgical removal of the bladder). If you are unsure, don’t hesitate to ask your doctors for clarification. In the case of bladder cancer, which often tecurs or spreads to other organs, you will have a much better chance of a cure once organs and tissue have been removed in areas where the disease is likely to spread or where it may already have infiltrated. And a cure, after all, is what you and your doctors are striving to attain.
Sometimes if the cancer is very localized and surrounded by plenty of healthy, noncancerous tissue, a partial cystectomy might be recommended. During this procedure, only a portion of the bladder is removed and some or all of the surrounding organs may be saved. You probably have already figured out that cystectomy is a surgical procedure performed under general anesthesia in a hospital setting. Depending on what kind of bladder reconstruction you have, you may stay in the hospital anywhere from 5 to 14 days. The descriptions included here of medical procedures and treatments are of a general nature; your own experience may differ somewhat because there are many different ways of carrying out these procedures.
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