BLADDER CANCER TREATMENTS

Treatment for bladder cancer depends on the stage of the tumor. The patient's medical history, overall health status, and personal preferences are also taken into account when deciding on an appropriate treatment plan. The three standard modes of treatment that are available for bladder cancer are surgery, radiation therapy, and chemotherapy. In addition, newer treatment methods such as photodynamic therapy and immunotherapy are also being investigated in clinical trials.

Surgery is considered an option only when the disease is in its early stages. If the tumor is localized to a small area and has not spread to the inner layers of the bladder, then the surgery is done without cutting open the abdomen. A cytoscope is introduced into the bladder through the urethra, and the tumor is removed through it. This procedure is called a transurethral resection (TUR). Passing a high-energy laser beam through the cytoscope and burning the cancer may treat any remaining cancer. This procedure is known as electrofulguration. If the cancer has invaded the walls of the bladder, surgery will be done through an incision in the abdomen. Cancer that is not very large can be removed by partial cystectomy, a procedure where a part of the bladder is removed. If the cancer is large or is present in more than one area of the bladder, a radical cystectomy is done. In this operation, besides the entire bladder, the adjoining organs may also be removed. In men, the prostate is removed, while in women, the uterus, ovaries, and fallopian tubes are removed.

If the entire urinary bladder is removed, then an alternate storage place must be created for the urine to be stored before it is excreted out of the body. To do this, a piece of intestine is converted into a small bag and attached to the ureters. This is then connected to an opening (stoma) that is made in the abdominal wall. The procedure is called a urostomy. In some urostomy procedures, the urine from the intestinal sac is routed into a bag that is placed over the stoma in the abdominal wall. The bag is hidden by the clothing and has to be emptied occasionally by the patient. In a different procedure, the urine is collected in the intestinal sac, but there is no bag on the outside of the abdomen. The intestinal sac has to be emptied by the patient, by placing a drainage tube through the stoma.

Radiation therapy that uses high-energy rays to kill cancer cells is generally used after surgery to destroy any remaining cancer cells that may not have been removed during surgery. If the tumor is in a location that makes surgery difficult, or if it is large, radiation may be used before surgery to shrink the tumor. In cases of advanced bladder cancer, radiation therapy is used to ease the symptoms such as pain, bleeding, or blockage. Radiation can be delivered by external beam radiation where a source of radiation that is outside the body focuses the radiation on the area of the tumor. Occasionally, a small pellet of radioactive material may be placed directly into the cancer. This is known as interstitial radiation therapy.

Chemotherapy uses anticancer drugs to destroy the cancer cells that may have migrated to distant sites. The drugs are introduced into the bloodstream by injecting them into a vein in the arm or taking them orally in pill form. Generally a combination of drugs is more effective than any single drug in treating bladder cancer. Chemotherapy may be given following surgery to kill any remaining cancer cells. It may also be given even when no remaining cancer cells can be seen. This is called adjuvant chemotherapy. Anticancer drugs, including thiotepa, doxorubicin, and mitomycin, may also be instilled directly into the bladder (intravesicular chemotherapy) to treat superficial tumors.

Immunotherapy or biological therapy, uses the body's own immune cells to fight the disease. To treat superficial bladder cancer, bacille Calmette-Guerin (BCG) may be instilled directly into the bladder. BCG is a weakened (attenuated) strain of the tuberculosis bacillus that stimulates the body's immune system to fight the cancer. This therapy has been shown to be effective in controlling superficial bladder cancer.

Photodynamic treatment is a novel mode of treatment that uses special chemicals and light to kill the cancerous cells. First, a drug is introduced into the bladder that makes the cancer cells more susceptible to light. Following that, a special light is shone on the bladder in an attempt to destroy the cancerous cells.