Bladder Cancer Treatments

Medically Reviewed by Dr. K on 23 May 2022

Bladder Cancer Treatments Overview

There are several treatment choices available if you have bladder cancer. Your surgeon will assist you in determining the right care option for you. This can be determined by a variety of factors, including your age, the extent to which the cancer has advanced (cancer's “stage"), and any other health issues you might have.

Surgery is needed in many cases of bladder cancer. However, it might not be able to fully cure the condition in certain circumstances. As a result, you'll require other treatments in addition to, or because of, surgery. Chemotherapy, nuclear, and immunotherapy are examples of these treatments.

Surgery

The most popular operation for bladder cancer in its early stages is transurethral resection of bladder tumour (TURBT), also known as transurethral resection (TUR).

It's a technique that involves taking tissue samples from within your bladder to see whether you have tumours, whether a tumour has grown, or to remove a tumour.

A blood test and a chest X-ray will be needed to ensure that you are well enough for TUR operation, but the surgeon will not need to create a cut in your skin. They access your bladder from your urethra, which is the channel through which urine exits your body.

You'll receive either general anaesthesia, which puts you to sleep, or regional anaesthesia, which numbs just the lower half of the body, during the operation. When the drug begins to operate, the treatment begins.

Your surgeon would use a cystoscope, which is a large, narrow, translucent tube with a cutting instrument, a lamp, and a camera at one end. They insert it through your bladder through your urethra. The surgeon can see the interior of your bladder thanks to the video.

A resectoscope, a related device, may be inserted through your bladder via your urethra and it is done with a wire coil.

They'll remove tissues or tumours using the cutting instrument or the wire loop, and apply heat to the places near the wound to avoid the bleeding (cauterisation).

The tissue that is removed will be examined under a microscope in a lab to determine if it is cancerous.

Following the operation, you'll get a catheter in your bladder. It removes urine from the body and deposits it in an external bag. It's possible that you'll need to keep it in for a couple days until you can urinate on your own. When you have a catheter, you may get up and exercise, although it might be uncomfortable as the anaesthesia wears off.

After the procedure, men can experience pain at the tip of their penis. If this happens, be sure to tell the surgeon or nurse. A numbing gel can be used to relieve discomfort.

Many patients are able to return home the same day as their treatment. However, if the tumour was large, you might continue to spend the night in the hospital for monitoring.

It's possible that you'll have blood in your urine for up to three days following surgery. To help empty out the kidneys, drink plenty of water. Your surgeon may also prescribe IV fluids for you. Flushing your body with fluids can also aid in the prevention of infection.

After the surgery, do not lift heavy objects or overexert for 2 or 3 weeks. Short walks are fine, but over the next 4 to 6 weeks, avoid any strenuous activities. Consult the surgeon on when you'll be able to drive and return to work.

Cystectomy

Your surgeon will extract part of your bladder (partial cystectomy) or all of it (radical cystectomy) during this procedure.

Your surgeon will be prepared to do a partial cystectomy if the cancer has spread to the muscular layer of your bladder and is still thin. However, most patients who have cancer that has spread to the bladder muscle would need more intensive surgery.

If the cancer has spread to more than one section of your bladder, the surgeon would most certainly resect the whole organ as well as the lymph nodes in the region. This procedure is known as a radical cystectomy.

If the cancer has progressed to other parts of your body, your surgeon will be able to resect adjacent reproductive organs and tissues as well. The uterus, cervix, a portion of the vaginal canal, the ovaries, and the fallopian tubes are also examples of female reproductive organs. This generally refers to the prostate gland, although it may also refer to the seminal vesicles and the vas deferens in males.

You will be offered medications to keep you asleep during these treatments. After that, you may have to remain in the hospital for up to a week. In a few weeks, you should be able to resume your normal routine.

Intravesical Therapy

This treatment is also used to treat tumours in their early stages. A catheter is used by the surgeon to administer a liquid solution directly into your bladder. They would have to pick between immunotherapy and chemotherapy (also known as “chemo").

  • Immunotherapy: The cancer cells are attacked by your body's immune system in this process. A bacteria called Bacillus Calmette-Guerin (BCG) will be injected into your bladder via a catheter by your surgeon. The bacteria that causes tuberculosis is similar to this one. This attracts the immune cells in your body to your bladder. They are triggered by BCG and continue to battle cancer cells there.
  • Intravesical chemotherapy (“chemo”): If you and your surgeon agree on this treatment, a catheter will be used to insert chemotherapy medications into your bladderto kill the cancerous cells.

Chemotherapy

Chemotherapy can be administered orally or intravenously. This ensures that the drug spreads across the body through your bloodstream. It has the ability to destroy cancer cells that have migrated outside of your bladder.

Chemotherapy is provided in stages, allowing you time to recover during therapies. Each stage is normally a few weeks long, with a cumulative treatment period of many months.

If you're undergoing operations, you'll almost certainly get chemotherapy beforehand. It has the ability to shrink cancers, making them simpler to remove and operation smoother. This further reduces the chances of the cancer returning.

The chemo medication cisplatin is often used to treat the most common form of bladder cancer, urothelial carcinoma. Cisplatin acts by preventing cancer cells from reproducing by destroying their DNA.

Cisplatin is often used in combination with other chemotherapeutic medications.

The following are the most common combinations:

  • Cisplatin, methotrexate, and vinblastine (CMV)
  • Gemcitabine and cisplatin (GC)
  • Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC)
  • Paclitaxel, gemcitabine, and cisplatin (PGC)

When the kidneys are not functioning well, you'll be given a particular combination of chemotherapy medications, such as carboplatin and paclitaxel, gemcitabine, or docetaxel.

Following surgery, your surgeon can prescribe chemo to destroy any cancer cells that remain in your body but are too small or disseminated to be removed by your surgeon. It reduces the chances of the cancer returning.

Radiation Therapy

High-energy radiation is used to destroy cancer cells in this treatment. It's similar to having an X-ray, but far more efficient. It's possible that you'll require radiation five days a week for many weeks.

It could be recommended by your surgeon for one of the following reasons:

  • You have bladder cancer in the early stages.
  • You have early-stage cancer and are unable to undergo treatment.
  • As a follow-up procedure to TURBT (transurethral resection of the bladder) or partial bladder resection surgery
  • To prevent or treat symptoms of advanced bladder cancer.

Treatments After or Instead of Surgery

To avoid surgery to remove the bladder, surgeons can combine chemotherapy and radiation therapy. If you're not in decent enough shape for surgery, it might be a viable choice. You'll most likely be given cisplatin alone, cisplatin and fluorouracil, or mitomycin and fluorouracil in this situation.

If the cancer has progressed into the muscular layer of the bladder but hasn't spread anywhere, you can still get chemotherapy and radiation following treatment.

If the cancer progresses following chemo, you can try different chemotherapy medications or other treatments, such as immunotherapy.

 

Immunotherapy

The immune response is used to attack the cancer in this procedure. It aids the immune system in recognising cancer cells as threats and launching a more effective attack on them. This can cause tumours to diminish or stop developing.

Bladder cancer that has progressed is treated by a variety of immunotherapy medications. Checkpoint inhibitors are the name for these medications. Checkpoint proteins are used by the body to prevent your immune system from destroying healthy cells. They assist the immune system in identifying amongst natural cells that should be left alone and attackers that should be targeted.

By linking to the cells that are meant to battle cancer, cancer cells will deceive the immune system. When this occurs, the checkpoint instructs the body to refrain from attacking. These cells are prevented from binding by a checkpoint inhibitor. Your immune system can then detect and target the cancer.

Several immunotherapy medications have been licenced by the FDA for people with metastatic bladder cancer that worsened during chemo. Atezolizumab (Tecentriq), avelumab (Bavencio), durvalumab (Imfinzi), enfortumab vedotin-ejfv (Padcev), nivolumab (Opdivo), and pembrolizumab (Opdivo) are the drugs in question (Keytruda).

These medications are delivered by infusion every 2-3 weeks, which means they are given through a tube (an IV) that is inserted into a vein.

Immunotherapy has the advantage of using your body's own defences. And after the therapy has completed, your immune system will be able to kill cancer cells because it has improved its recognition of cancer cells.

 

Other Immunotherapies for Bladder Cancer

Other new immunotherapy medications are being tested to see how effective they perform on their own and in combination with other therapies.

They're still experimenting with immunotherapy variations. Early findings found that nivolumab in combination with another medication, ipilimumab, was effective in 26% to 38% of those who took it.

Atezolizumab is now being used in tandem with MTIG7192A, another checkpoint inhibitor.

 

Bladder Cancer Clinical Trials

Major pharmaceutical companies are constantly researching and developing innovative bladder cancer drugs and therapies that should be shown to be safe and successful before surgeons can recommend them to patients. Researchers use clinical experiments to assess the effectiveness of experimental medications on a population of bladder cancer patients. Researchers test investigational drugs in progress by using a stringent regimen and utilising carefully monitored conditions to assess the experimental drug's capacity to cure bladder cancer, as well as its efficacy and any potential short and long term side effects.

Some patients are unable to participate in research trials because they are afraid of receiving no medication at all (placebo). Patients who take part in clinical trials, on the other hand, may obtain the most appropriate medication currently available for their disease, or drugs that are being tested for potential usage. These bladder cancer medications may be much more successful than the existing therapy options. The best way to find out is to compare them in a clinical study.

Ask your doctor about information on clinical trials in your area.

Sources

Referenced on  2/5/2021 

  1. American Cancer Society: “Bladder Cancer Treatment,” “Bladder Cancer Surgery,” “Radiation Therapy for Bladder Cancer,”  “Chemotherapy for bladder cancer,” “FDA Approves New Immunotherapy Drug for Bladder Cancer,” “Immunotherapy for bladder cancer.”
  2. National Cancer Institute: “Bladder Cancer Treatment (PDQ) — Patient Version,” “FDA Approves Immunotherapy Drugs for Patients with Bladder Cancer,” “FDA Approves New Immunotherapy Drug for Bladder Cancer,” “Immunotherapy.”
  3. American Society of Clinical Oncology: “Bladder Cancer: Treatment Options.”
  4. Cancer Research UK: “Trans Urethral Removal of Bladder Tumour.”
  5. University Hospital Southampton: “Transurethral Resection of Bladder Tumor Information for Patients.”
  6. University of Cincinnati Cancer Center: “Treating Bladder Cancer: TUR (Transurethral Resection).”
  7. NYU Langone Medical Center: “Intravesical Treatment for Bladder Cancer,” “Radiation Therapy for Bladder Cancer,” “Surgery for Bladder Cancer,” “Chemotherapy and New Treatments for Bladder Cancer.”
  8. Memorial Sloan Kettering Cancer Center: “Neoadjuvant Chemotherapy for Bladder Cancer,” “Bladder Cancer Clinical Trials and Research,” “Immunotherapy,” “FDA Approves ‘Game Changer’ Immunotherapy Drug for Bladder Cancer,” “A Phase II Study Assessing Mediators of Response to Nivolumab and Ipilimumab Immunotherapy in Patients with Advanced Melanoma or Bladder Cancer,” “A Phase I/IB Study of Immunotherapy with CPI-444 Alone and with Atezolizumab in Patients with Metastatic Solid Tumors.”
  9. FDA: “FDA approves new, targeted treatment for bladder cancer,” “Nivolumab for Treatment of Urothelial Carcinoma.”
  10. ISRN Urology: “Metastatic Bladder Cancer: A Review of Current Management.”
  11. The University of Texas MD Anderson Cancer Center: “Q&A Understanding Immunotherapy,” “Nivolumab immunotherapy helps patients with advanced bladder cancer,” “Immune checkpoint inhibitors shrink tumors in 26 to 38 % of metastatic bladder cancer patients.”
  12. American Society of Clinical Oncology: “Patients With Advanced Bladder Cancer Benefit From Anti-PD-L1 Immunotherapy.”
  13. The Lancet: “Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial.”
  14. https://www.webmd.com/cancer/bladder-cancer/understanding-bladder-cancer-treatment

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