Ava Saidian, MD, on unique considerations for female patients with bladder cancer

In this video, Ava Saidian, MD, highlights differences in the way that she counsels male vs female patients with bladder cancer. Saidian is a urologic oncologist and assistant professor of urology at the University of Tennessee Health Science Center in Memphis, Tennessee.

Video Transcript:

When considering treatment for bladder cancer, specifically in women, I have 2 schools of thought in terms of their disease. In non–muscle-invasive bladder cancer, which is what most people present with––about 70% of patients present with non-muscle-invasive [disease]––the actual treatment itself doesn't really differ between men and women for me. However, how I counsel them about the treatment is different. For example, most of the time we're using intravesical chemotherapy. In women, I counsel them on the importance of, for example, after getting intravesical chemotherapy, on cleaning and prepping the skin, because they can have skin irritation or toxicity vs in men, they tend to be more continent. It's easier to hold the chemotherapy in compared to women who might have some leakage and stuff like that. I think some institutions even use barrier creams around the vulva and urethra to help protect the skin when they're getting intravesical chemotherapy.

The other thing is, I am a huge proponent of topical hormone therapy in and around the vagina, vulva, and urethra, so vaginal estrogen and DHEA. Anecdotally, it helps decrease a lot of the symptoms, the irritability, that comes with treating non–muscle-invasive bladder cancer.

Now for muscle-invasive [disease], how I counsel patients on surgery when they're a man vs a woman is almost completely different, because their anatomy is very different. For women, if they are going to undergo a radical cystectomy, historically, we used to take everything––the vagina, the uterus, the ovaries––but that is very much changing. We have lots of good data showing us that we can safely preserve these organs in women if it's oncologically sound. I tell all my female patients at the end of the day, we're treating your cancer, so I'm going to do what's best for your cancer. But after that, I want to talk to you about what you want your functional outcomes to be in terms of urinary function and sexual function. That starts by doing a good pelvic exam and examin[ing] their bladder to stage their disease. If they're a good candidate, I will attempt to spare their vagina [and] their uterus, at the very least. In almost all patients, we have good data showing us that we can spare their ovaries, especially in women under the age of 75. That has a lot of impact in the future on their sexual health, even cognitive function, muscle preservation, all of that stuff that will lend to them having a better quality of life afterwards.

This transcript was AI generated and edited by human editors for clarity.