What are the treatment options for bladder cancer?
What are the treatment options for bladder cancer?
There are four types of treatment for patients with bladder cancer. These include:
- Surgery
- Chemotherapy
- Intravesical chemotherapy or immunotherapy for superficial cancers
- Radiation therapy
Sometimes, combinations of these treatments will be used.
Surgical options
Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.
- Transurethral resection of the bladder is used most often for early stage disease (TA, T1, or CIS). It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated (destroyed with an electric current).
- Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
- Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder (or several early tumors over a large portion of the bladder).
This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.
Because the bladder is removed, a procedure called a urinary diversion must be done so that urine can exit the body. A pouch constructed of intestine may be made inside the body, or a leak-proof bag worn outside the body may be used to collect urine. The procedure typically requires a hospital stay of five to six days, give or take a few either way.
Chemotherapy
Chemotherapy refers to the use of any of a group of drugs whose main effect is either to kill or slow the reproduction of rapidly multiplying cells. Cancer cells absorb chemotherapy drugs faster than normal cells do (but all cells are exposed to the chemotherapy drug). Chemotherapy drugs are delivered intravenously (through a vein) or can be delivered intravesically (directly into the bladder through a catheter threaded through the ureter), depending on the stage of the cancer.
Some common chemotherapy drugs that are used for the treatment of bladder cancer include:
- Methotrexate
- Vinblastine
- Doxorubicin
- Cyclophosphamide
- Paclitaxel
- Carboplatin
- Cisplatin
- Ifosfamide
- Gemcitabine
Many of these drugs are used in combinations.
Side effects can occur with chemotherapy, and their severity depends on the particular drug used and the ability of the patient to tolerate the drugs. Common side effects from chemotherapy include:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Tiredness from anemia
- Vulnerability to infections
- Ulcers or sores in the mouth
Chemotherapy can be used alone, but is often used with surgery or radiation therapy.
Intravesical therapy
Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) immunotherapy or chemotherapy.
Immunotherapy refers to using the body's own immune system to attack the cancer cells. A vaccine called Bacillus Calmette-Guérin (BCG) is commonly used for this purpose in the intravesical treatment of stages Ta, T1, or carcinoma in situ (limited to the innermost lining) bladder cancers. In the procedure, a solution containing BCG is retained in the bladder for a few hours before being drained.
Intravesical BCG is usually given once a week for six weeks, but sometimes long-term maintenance therapy is needed. Bladder irritation, pain or burning during urination, and low-grade fever and chills are possible side effects of intravesical BCG.
Intravesical chemotherapy with mitomycin C is another treatment option. Because the chemotherapy is given directly into the bladder, other cells in the body aren't exposed to the chemotherapy, which reduces the chances for side effects from the chemotherapy. It's also often given as a single dose after a tumor has been removed via cystoscopy.
Radiation therapy
Radiation therapy damages the DNA of cancer cells by bombarding them with high-energy X-rays or other types of radiation. It may be an alternative to surgery or used in combination with surgery or chemotherapy. Radiation therapy can be delivered externally or internally.
In external radiation therapy, the radiation source is a machine outside the body that directs a focused beam of radiation at the tumor. With better imaging technologies in use today, computer-guided radiation delivered from several angles minimizes radiation exposure to surrounding tissues and organs, limiting damage to these tissues. Fatigue, swelling of soft tissues and skin irritation are common side effects of external radiation.
Internal radiation therapy is not often used for bladder cancer. In this type of treatment, a radioactive pellet is inserted into the bladder through the urethra or an incision in the lower abdomen. Internal radiation requires a hospital stay during the course of treatment, which can be several days, after which the pellet is removed.