The treatment of bladder cancer often involves a range of specialists from different fields including a clinical oncologist (cancer specialist), a radiologist, a pathologist, a social worker, a psychologist and a cancer nurse.
Treatment plan for non-muscle-invasive bladder cancer
In cases of non-invasive bladder cancer, the type of treatment is usually determined by various factors that predict patient outcome. Examples of these factors include size and location of the tumor, tumor number, cancer aggression level and whether there is any family history of bladder cancer.
If the risk of the cancer growing or spreading is low, surgery to remove the tumor is usually recommended, followed by localized chemotherapy to reduce the risk of the cancer recurring.
To remove a non-invasive bladder cancer, a procedure called transurethral resection of the bladder tumor (TURBT) is the most commonly chosen technique. In the majority of cases, a TURBT can be carried out during a biopsy procedure. The surgery is performed under general anaesthesia using a cystoscope to locate and cut away the tumor.
Chemotherapy may be given in two forms. Systemic chemotherapy is administered intravenously or injected into a muscle while local chemotherapy is targeted directly at the area affected by cancer. One form of local chemo is intravesical chemotherapy, where a solution of anticancer agents are placed directly into the bladder using a catheter.
These drugs kill actively growing cancer cells and examples of the most commonly used agents are mitomycin and thiotepa. The solution is left in the bladder for about an hour before being drained away. The urine may contain some of the medication, so washing with soap and water is recommended after urination to prevent skin irritation.
Systemic chemotherapy kills any rapidly dividing cells including cells that are not cancerous. This can cause various side effects such as nausea, vomiting, diarrhea, reduced appetite, hair loss and mouth ulcers. This form of therapy can also suppress the bone marrow causing anemia, infection and a tendency to bleed. With the use of intravesical chemotherapy, these side effects can be avoided. The most common side effect of intravesical chemotherapy is irritation of the bladder lining, which passes in a few days.
Bacillus Calmette-Guérin (BCG) vaccine
Another intravesical treatment that may be given is the Bacillus Calmette-Guerin (BCG) vaccine. This is the most effective form of intravesical immunotherapy for early-stage bladder cancer. The presence of BCG in the bladder attracts the body’s immune cells, which then destroy the bladder cancer cells.
Treatment plan for muscle-invasive bladder cancer
Patients with muscle-invasive bladder cancer often have a less positive outlook than those with non-invasive cancer or cancer that has not yet invaded the muscle. The treatment recommended depends on the extent to which the cancer has spread. Cancer that has reached stages T2, T3 or T4, is often treated with a combination of chemotherapy, radiotherapy and surgery.
The most common treatment method for muscle-invasive bladder cancer is radical cystectomy. This involves removal of the whole bladder as well as the nearby lymph nodes and some of the urethra. In men, the prostate is also removed and in women, the cervix and uterus is removed. An alternative outlet for urine is created during the procedure and is called a urinary diversion.
Radiotherapy kills cancer cells using pulses of radiation. Radiotherapy may be administered as a primary treatment to try and cure bladder cancer in people who cannot tolerate surgery. Radiotherapy may also be used as a palliative therapy to help relieve symptoms and ease suffering in cases of incurable cancer.
Radiotherapy can lead to numerous side effects such as diarrhea, local skin inflammation, pain on urination, infertility and erectile dysfunction.
Intravenous chemotherapy may be given before radiotherapy to shrink the size of any tumors. The therapy may also be given in combination with radiotherapy before surgery or as a form of palliative therapy in cases of advanced cancer.
Reviewed by Sally Robertson, BSc