"Surgery plays a very important part in the treatment of bladder cancer, both in the initial diagnosis and in the subsequent care and eventual treatment of both surface or non-muscle invasive bladder cancer. And deep or muscle invasive bladder cancer. Let me give you some examples. When a patient is initially diagnosed with a tumor in the bladder, a procedure under anesthesia called transurethral resection of bladder tumor, abbreviated TURBT, will be performed under full anesthesia. The doctor places a camera through the urethra into the bladder without cutting the patient open. The doctor then fills the bladder up with fluid so that it can be distended, because normally the bladder, which is hollow, is collapsed, and they can look around the bladder with a camera and see the growth, which is forming from the wall of the bladder. So it's stuck to the wall. There's an electrical instrument called a resectoscope. You can think of it like an electrical carrot peeler. In this procedure, the tumor is shaved down until it's no longer visible. The shaving continues until it's flush with the bladder wall. And all those shavings of cancer growth are flushed out of the body and given to a pathologist to look under the microscope because we're very interested to know if there are roots of the growth that go deep into the muscle wall. The doctor then excavates a little divot under where the growth was forming. He or she sends those deep layers to be evaluated under the microscope as well. It's a delicate procedure, because if the excavation is done too deeply into the wall of the bladder, a hole could be made. We don't want to poke a hole in the wall of the bladder, but it's a small risk with this procedure. In this way, the cancer diagnosis can be made and the depth of invasion, or whether there are roots in the wall, can be determined. In more advanced cases of bladder cancer where the cancer does invade into the wall of the bladder, there's a higher risk of spread. Another word for spread is metastasis. In those cases, a combination of chemotherapy and total removal of the bladder surgically, which is a major operation, is typically recommended."
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