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Bladder cancer services

 

About bladder cancer

Bladder cancer is the second most common urological cancer. Every year, 10,500 new cases are diagnosed and 5,000 patients die of this disease. It is three to four times more common in men than women. It can occur at any age but is generally diagnosed in patients aged 60-80.

The most common risk factor is history of smoking, which increases the risk of this cancer by four times. Patients normally notice blood when they pass urine (haematuria). Presence of visible blood in the urine therefore requires urgent investigation. Repeated urine infections or need to pass urine frequently and urgently are other possible symptoms. The most common tumour is transitional cell carcinoma (TCC). These tumours can affect the inner lining of the kidney and ureter (pipe from kidney to bladder). 

Diagnosing and treating bladder cancer

Patients are initially investigated in the one-stop clinic where they have an ultrasound examination of their urinary tract and a flexible cystoscopy (inspection of the bladder using a fibre-optic telescope). Urine samples are sent to the laboratory to look for abnormal cells. The type of cancer you have will determine the treatment you need.

Bladder cancer service at Guy's

Expand the following information areas to find out more about our service.

  • Team

    The bladder cancer team consists of highly experienced urological surgeons, uro-radiologists, uro-pathologists, oncologists, a bladder cancer nurse specialist, fast track recovery nurse, dietician, physiotherapist and a team of stoma nurses.

    The 'Older Persons Assessment Unit' is also available throughout the clinic to assess patients' fitness for surgery (if over 65 years of age), and also to optimise patients medically who are being considered for surgery or radiotherapy.

  • Clinic

    Every Friday morning at Guy's, we hold a clinic for patients with bladder cancer. There is a multi-disciplinary briefing session at the start of the clinic which is attended by all the team members to discuss the clinical information, review each patient's x-rays and histology (tissue samples) and formulate an individual management plan for each patient due to be seen on the day. Thus when the patients are seen in clinic, they will have had the benefit of everyone’s expertise, not just of the person they are seeing. 

    Complex cases are discussed at a weekly specialist meeting involving surgical teams from other hospitals. We regularly give second opinions to patients from around the country to try and help them understand the disease they have.

  • Diagnostics

    Patients who need a check cystoscopy (telescope examination of the bladder under local anaesthetic) for their follow up can have this done in the clinic so that they do not need to come back for another appointment. The service has access to the modern diagnostic techniques of Photodynamic (Blue Light) Cystoscopy and Narrow Band Imaging.

  • Treatment / Rehabilitation

    There is an outpatient service delivering laser treatment to bladder tumours under local anaesthetic, which allows frail elderly patients to be treated without general anaesthesia and as outpatients. Combination treatment with BCG and electromotively administered (a special device for better penetration) Mitomycin (chemotherapy) into the bladder has been our standard regimen for patients with high-risk superficial bladder cancer which have enabled many patients to avoid removal of the bladder.

    New instruments for transurethral resection have been designed by the team in conjunction with Karl Storz for en bloc ‘sand wedge’ resection of removing the bladder tumour without spillage of tumour cells as can happen with conventional loop resection techniques.

    The Guy’s team pioneered the robotic cystectomy technique in 2004. Patients for radical cystectomy are offered the option of open or robotic cystectomy approach and choice of all types of urinary diversions (ileal conduit, continent urinary diversion or orthotopic bladder substitutions) appropriate to the individual clinical situation.

    Enhanced Recovery After Surgery (ERAS) programme has been introduced to enable patients for a faster post-operative recovery, improve their experience and shorten length of stay. This programme is driven by a dedicated nurse.

    The oncology aspects of the bladder cancer team are managed by a dedicated team. All neo-adjuvant, adjuvant and palliative chemotherapy for the network is delivered from a single bladder oncology clinic at Guy's Hospital.

    Younger patients keen on maintaining sexual function are offered a nerve sparing option if clinically appropriate and penile rehabilitation is provided following surgery driven by a nurse specialist.

    Truly advanced access is available for emergency re-attendance to clinic.

    The bladder team is actively involved in clinical trials, has national and international reputation for its innovative work in bladder cancer, is one of the leading European contributors to the International Robotic Cystectomy Consortium (IRCC) and is well represented in the International Bladder Cancer Network (one clinical oncology consultant, one urology consultant and one histopathology consultant).

    There is access to palliative radiotherapy within 14 days of consent for treatment (unless patients opt otherwise). All radical radiotherapy for bladder cancer is delivered using IGRT to ensure accuracy of treatment delivery and allow patients to have their treatment re-planned if necessary either to ensure adequate tumour coverage or reduce predicted toxicity.

  • Support group

    There is a bladder cancer support group held once a month in the urology centre at Guy's. See the support group page for more information.

Preparing for your operation

Watch our preparing for your operation film to find out what you can expect during your care with us before, during and after an operation and how you can help your recovery after surgery.

  • Preparing for your operation – video transcript

    Mr Jonathan Olsburgh (consultant surgeon): In this video we're going to talk about what you can expect during your care with us before, during and after an operation and what steps you can take to assist your recovery and help you to get home as quickly as possible.

    This is often referred to as the enhanced recovery programme.

    These principles apply to any kind of operation. Evidence shows that being prepared for your operation both mentally and physically will help your recovery. You will know what to expect, what you can do to make yourself feel better. This is a key element of enhanced recovery.

    Applying enhanced recovery principles before your operation helps ensure you're better prepared by looking at exercise and diet; if appropriate stopping smoking or reducing alcohol; thinking about your home circumstances and having information on what to expect at each stage.

    Ian Wicks (kidney transplant patient): I spoke to my doctor when I turned out for my regular appointments about what to expect and things like that helped. I'm someone who likes to know information in advance it helps me process it a bit better. Back in the education sessions it was, don't smoke if you smoke, don't drink if you drink.

    Start to manage your diet a little bit differently, which we did, and in terms of the diet I think that was the thing that probably helped the most given guidance on what things would be good for me to eat the things that wouldn't be so good for me to eat. I think having that information and also listening to it is really important.

    Kathryn Chatterton (clinical nurse specialist): When I first meet you I'll be introduced to you by my consultant and then we'll be able to go through before and after what's going to be happening to you during your surgery. You'll also be given the opportunity to ask me any questions and also I'll make sure that you have the appropriate literature for you to have with regards to your surgery.

    Before your surgery you'll attend a pre-assessment clinic or a seminar which will be with a group of patients that are all undergoing the same surgery. Depending on the type of surgery and length of surgery there are a few members of the health care professional team that you may meet.

    You may meet the clinical nurse specialists who will be able to go through any additional questions that you're unsure about regarding your surgery. You will also meet a physiotherapist. They may be able to help you with any exercise to help you for pre and post-surgery and also, perhaps depending on the surgery, a pharmacist.

    Our dietitians can give guidance on nutrition before your surgery and how to look after yourself nutritionally when you're discharged. Some patients may be asked to drink a special carbohydrate drink which will help prepare your body for the operation and will help you with your recovery.

    Anna Mae Salvador (ward manager): The nurses will prepare you for surgery and when you're ready you'll be taken to an anaesthetic room and from there you're going to the operating room. After an operation most patient will wake up in the recovery room where you will be monitored until you're ready to go back to the ward.

    If you have had complex surgery or have complex medical needs you may move to a more specialist unit to be monitored through the initial recovery before being moved to the ward.

    It is important to get up and get moving as soon as you can after your operation. Most patients can start gentle exercises in bed and maybe sit out in a chair with assistance from the nurse on the same day of the operation. Movement will really help your recovery.

    The team looking after you will make sure you start eating and drinking at the right time after your operation, building this up gradually. We will also ask you if you have any pain or nausea and will help you manage this.

    Ian Wicks: I think it was on day one after the operation I should be getting out of bed and sitting up for a little while and I think that gave me the kind of the kick to get up and do it, thinking with that's what I've been told to do that's got to be the right thing to do even if it hurts. So get up, get out of bed and just try and do what the little booklet told me to do.

    I think having like a plan laid out, almost like a diary of what to expect, was really helpful, and I think in some ways you almost want to psychologically to try and beat it a little bit because I think it ran for five or six days, the programme. It was nice to know that I could sit in a chair longer than they expected me to sit in a chair for example. So that was a bit of a challenge almost to try and do better than it was laying out for you.

    Mr Jonathan Olsburgh: The important thing to remember is that every patient we see gets personalised care and is based around giving you the best possible experience and fastest possible recovery. The experience of Ian is an example of enhanced recovery to best support a transplant patient, many of the principles apply regardless of the type of operation you require.

    Ian Wicks: I went home three and a half days after the operation and I felt ready to go.

    Mr Jonathan Olsburgh: We're always happy to answer your questions so please do ask a member of your care team.