Treatment of Bladder Cancer
The treatment for bladder cancer depends on the stage of the disease, the type of cancer, and the patient's age and overall health. Options include surgery, chemotherapy, radiation, and immunotherapy. In some cases, treatments are combined (e.g., surgery or radiation and chemotherapy, preoperative radiation). Bladder cancer cases are seen in each of our locations, Poughkeepsie, Fishkill, Kingston and Rhinebeck. SurgeryThere are two main surgeries for bladder cancer. Transurethral resection (TUR) removes cancerous growths from the bladder. Cystectomy removes all or part of the bladder if cancer has spread into the bladder muscle. The type of surgery depends on the stage of the disease. In early bladder cancer, the tumor may be removed (resected) using instruments inserted through the urethra (transurethral resection).
Transurethral resection (TUR) is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder.
Cystectomy is the surgical removal of all (total or radical cystectomy) or part (partial cystectomy) of the bladder. It is used to treat bladder cancer that has spread into the bladder wall as either a first occurrence or as a cancer that returns (recurs) following initial treatment. A radical cystectomy removes the whole bladder and the surrounding pelvic organs.
When the bladder is removed, another way to store and release urine is needed. Options include:
Orthotropic diversion
In most cases, a piece of intestine is formed into a new bladder. This is attached to the urethra allowing urine to follow the usual path out of the body. This procedure allows normal urinations during the day, although leakage may occur at night. Some people may need to use a catheter to release the urine.
Urostomy
This procedure uses a segment of your intestine to create a channel that connects your ureters to a surgically created opening (stoma) on your abdomen. The urine passes from the ureters through the conduit and out the opening into a lightweight leak proof plastic bag that is attached to your skin. You will empty the bag 3 or 4 times a day. A larger bag that allows for longer storage can be worn overnight.
Abdominal diversion reservoir
In other cases, a piece of intestine may be formed inot a pouch, which can store urine. This is another form of urostomy. The opening is smaller than the opening for an ileal conduit. And because there is a pouch inside the abdomen, no bag needs to be worn outside your body. You will need to pass a catheter through the opening to release the urine several times a day and during the night.
Chemotherapy to Treat Bladder Cancer
Chemotherapy is a systemic treatment (i.e., affects the entire body) in which drugs are used to destroy cancer cells. Chemotherapy drugs are administered orally, intravenously (through a vein), or in early bladder cancer, may be infused into the bladder through the urethra (called intravesical chemotherapy). Chemotherapy can be administered before surgery or after surgery.
Side effects of chemotherapy drugs used to treat bladder cancer can be severe and include, abdominal pain, anemia, bladder irritation, blurred vision, excessive bleeding or bruising, fatigue, headache, infection, and/or loss of appetite.
Radiation Therapy
Radiation uses high-energy x-rays or other high-energy rays to destroy cancer cells. External beam radiation is emitted from a machine outside the body and is aimed at the bladder. This type of therapy be used after surgery to destroy cancer cells that may remain. Radiation therapy is also used to relieve symptoms (called palliative treatment) of advanced bladder cancer.
Side effects can include inflammation of the rectum, incontinence, skin irritation, blood in the urine, scar tissue formation, and impotence (erectile dysfunction).
Immunotherapy
This therapy, which is also called biological therapy, uses medicines that cause your body's immune system to attack bladder cancer cells. This treatment is used to enhance the immune system's ability to fight disease. A vaccine derived from the bacteria that causes tuberculosis (BCG) is infused through the urethra into the bladder, once a week for 6 weeks to stimulate the immune system to destroy cancer cells. Sometimes BCG is used with interferon.
During treatment, you're asked to hold the medication in your bladder for up to two hours, then urinate. If BCG is used, your doctor may advise you to pour bleach into your toilet after you urinate. This kills any leftover bacteria. Intravesical therapy is usually given weekly for 6 to 8 weeks. Depending on the medication used, you may be prescribed antibiotics to help prevent infection. If you have a fever at anytime during treatment, call your doctor.
Side effects can include inflammation of the bladder (cystitis), inflammation of the prostate (prostatitis), and flu-like symptoms. High fever (over 101.5°F) may indicate that the bacteria have entered the bloodstream (called bacteremia). This condition is life threatening and requires antibiotic treatment. Immunotherapy is not used in patients with gross hematuria (blood in urine).
Photodynamic therapy is a new treatment for early bladder cancer. It involves administering drugs to make cancer cells more sensitive to light and then shining a special light onto the bladder. This treatment is being studied in clinical trials.
Bladder Cancer Follow-Up
Bladder cancer has a high rate of recurrence. Urine cytology and cystoscopy are performed every 3 months for 2 years, every 6 months for the next 2 years, and then yearly.
Bladder Cancer Prognosis
Superficial bladder cancer has a 5-year survival rate of about 85%. Invasive bladder cancer has a less favorable prognosis. Approximately 5% of patients with metastasized bladder cancer live 2 years after diagnosis.
Bladder Cancer Prevention
The best way to lower the risk of bladder cancer is not to smoke. Studies have shown that drinking plenty of fluids daily also lowers the risk for bladder cancer.