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Urachal cancer is often diagnosed at later stages.

Based on your disease stage and predicted outcomes, recommended treatment may include:

  • Surgery
  • Chemotherapy
  • Palliative care

Recommended treatment and predicted outcomes will be based on your cancer stage. The planned treatment approach should be discussed by a multidisciplinary tumour board. This board is made up of practitioners from different medical specialties. They share their different professional opinions to plan appropriate care for individual cancer patients.

Surgery

Tumour removal

Surgery is recommended to remove a urachal cancer tumour that has not spread to other tissues or organs. The tumour will be removed along with surrounding tissue in the abdomen, the navel, and the top of the bladder to make sure no cancer cells remain.

In rare cases, some or all of the urinary bladder must be removed. The pelvic lymph nodes should be removed if imaging shows they are enlarged and/or look like cancer might be present or if they feel suspicious during the operation.

Bladder removal

If parts of your urinary bladder have to be removed, you will have a smaller bladder. This might lead to lower urinary tract symptoms like feeling an urgent need to urinate and frequent voiding. In rare cases, the whole bladder may need to be removed. In this case, a substitute reservoir (neobladder) or an artificial opening for passing urine (urinary stoma) must be built during the operation.

Diagnostic laparoscopy

This procedure may be advised if:

  • You have a large (>4 cm) tumour filled with mucus (mucinous cystic tumour)
  • Images of your abdomen show mucus floating freely

In a diagnostic laparoscopy, the inside of your abdomen is examined with a tube-like camera and one or two additional instruments while you are asleep (under general anaesthesia). If cancerous cells are found, a larger operation will be performed to remove all mucus and tumours, and chemotherapy drugs will be given directly in the abdomen to kill remaining cancer cells.

What to ask your doctor about urachal cancer surgery

  • Why do I need surgery?
  • Will I have to stay in hospital?
  • How long will I be in hospital?
  • What are the possible side effects of the surgery?
  • Will I have any pain?
  • Are there any possible complications?
  • How long will I need to be off work?

Chemotherapy

Systemic chemotherapy is not a substitute for surgical treatment, and it does not provide a cure.

Chemotherapy drugs containing platinum and 5-fluorouracil (5-FU) have shown success in:

  • Urachal cancer that has spread to other tissues or organs
  • Patients with a high risk of recurrence after the operation

What to ask your doctor about urachal cancer chemotherapy

  • Why do I need chemotherapy?
  • Are there other treatment options besides chemotherapy?
  • Which drugs will I have?
  • How do I take the drugs?
  • Will I have to stay in hospital?
  • What are the side effects?
  • Can I do anything to help prevent side effects?
  • Who can help me cope with side effects?
  • Who can I contact if I am worried about side effects?
  • What should I do if I get an infection?
  • How long will I have chemotherapy for?
  • How many courses of chemotherapy will I need?
  • How long will I need to be off work?
  • How can you tell if the chemotherapy is working?
  • How long will it take me to recover from the treatment?

Can chemotherapy or radiation before surgery help?

Little is known about the effectiveness of chemotherapy or radiation before surgery for urachal cancer. The most common type of urachal cancer is adenocarcinoma, which is known to respond to chemotherapy or radiation. However, no recommendations can be made at this time.

In addition, little is known about radiotherapy after surgery for urachal cancer, but it does not seem to have a positive effect.

Follow-up

After the operation, you will be scheduled for doctor visits and imaging at regular intervals (follow-ups). The purpose of these visits is to look for treatment side effects and to scan for possible recurrences.

Early detection of recurrence is crucial to make sure you are treated. A consultation and imaging should be scheduled between one to four times a year for 5 to 10 years after the operation. You should personally look for symptoms like blood or mucus in your urine, abdominal pain, or swelling. If you experience any of these symptoms, please contact your doctor.

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