Bladder Cancer Treatment
Types of bladder cancer
Different types of cells in your bladder can become cancerous. The type of bladder cell where cancer begins determines the type of bladder cancer. Doctors use this information to determine which treatments may work best for you.
Types of bladder cancer include:
. Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and cancers can form in those places as well. Urothelial carcinoma is the most common type of bladder cancer in the United States.
. Squamous cell carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder — for instance, from an infection or from long-term use of a urinary catheter. Squamous cell bladder cancer is rare in the United States. It's more common in parts of the world where a certain parasitic infection (schistosomiasis) is a common cause of bladder infections.
. Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is very rare.
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Bladder Cancer Treatment by Stage
Your doctor can rate bladder cancer with a staging system that goes from stages 0 to 4 to identify how far the cancer has spread. The stages of bladder cancer mean the following:
. Stage 0 bladder cancer hasn’t spread past the lining of the bladder.
. Stage 1 bladder cancer has spread past the lining of the bladder, but it hasn’t reached the layer of muscle in the bladder.
. Stage 2 bladder cancer has spread to the layer of muscle in the bladder.
. Stage 3 bladder cancer has spread into the tissues that surround the bladder.
. Stage 4 bladder cancer has spread past the bladder to the neighboring areas of the body.
Your doctor will work with you to decide what treatment to provide based on the type and stage of your bladder cancer, your symptoms, and your overall health.
. Treatment for stage 0 and stage 1
Treatment for stage 0 and stage 1 bladder cancer may include surgery to remove the tumor from the bladder, chemotherapy, or immunotherapy, which involves taking a medication that causes your immune system to attack the cancer cells.
. Treatment for stage 2 and stage 3
Treatment for stage 2 and stage 3 bladder cancer may include:
. Removal of part of the bladder in addition to chemotherapy
. Removal of the whole bladder, which is a radical cystectomy, followed by surgery to create a new way for urine to exit the body.
. Chemotherapy, radiation therapy, or immunotherapy that can be done to shrink the tumor before surgery, to treat the cancer when surgery isn’t an option, to kill remaining cancer cells after surgery, or to prevent the cancer from recurring.
. Treatment for stage 4 bladder cancer
Treatment for stage 4 bladder cancer may include:
. Chemotherapy without surgery to relieve symptoms and extend life
. Radical cystectomy and removal of the surrounding lymph nodes, followed by a surgery to create a new way for urine to exit the body.
. Chemotherapy, radiation therapy, and immunotherapy after surgery to kill remaining cancer cells or to relieve symptoms and extend life.
. Clinical trial drugs
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Bladder Cancer Treatment
Treatment options for bladder cancer
Treatment options for bladder cancer depend on a number of factors, including the type of cancer, grade of the cancer and stage of the cancer, which are taken into consideration along with your overall health and your treatment preferences.
Bladder cancer treatment may include:
. Surgery, to remove the cancer cells
. Chemotherapy in the bladder (intravesical chemotherapy), to treat cancers that are confined to the lining of the bladder but have a high risk of recurrence or progression to a higher stage.
. Chemotherapy for the whole body (systemic chemotherapy), to increase the chance for a cure in a person having surgery to remove the bladder, or as a primary treatment when surgery isn't an option.
. Radiation therapy, to destroy cancer cells, often as a primary treatment when surgery isn't an option or isn't desired.
. Immunotherapy, to trigger the body's immune system to fight cancer cells, either in the bladder or throughout the body.
. Targeted therapy, to treat advanced cancer when other treatments haven't helped.
A combination of treatment approaches may be recommended by your doctor and members of your care team.
Bladder cancer surgery
Approaches to bladder cancer surgery might include:
. Transurethral resection of bladder tumor (TURBT). TURBT is a procedure to diagnose bladder cancer and to remove cancers confined to the inner layers of the bladder — those that aren't yet muscle-invasive cancers. During the procedure, a surgeon passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away the cancer. Alternatively, a high-energy laser may be used.
Because doctors perform the procedure through the urethra, you won't have any cuts (incisions) in your abdomen.
As part of the TURBT procedure, your doctor may recommend a one-time injection of cancer-killing medication (chemotherapy) into your bladder to destroy any remaining cancer cells and to prevent cancer from coming back. The medication remains in your bladder for a period of time and then is drained.
. Cystectomy. Cystectomy is surgery to remove all or part of the bladder. During a partial cystectomy, your surgeon removes only the portion of the bladder that contains a single cancerous tumor.
A radical cystectomy is an operation to remove the entire bladder and the surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy may involve removal of the uterus, ovaries and part of the vagina.
Radical cystectomy can be performed through an incision on the lower portion of the belly or with multiple small incisions using robotic surgery. During robotic surgery, the surgeon sits at a nearby console and uses hand controls to precisely move robotic surgical instruments.
. Neobladder reconstruction. After a radical cystectomy, your surgeon must create a new way for urine to leave your body (urinary diversion). One option for urinary diversion is neobladder reconstruction. Your surgeon creates a sphere-shaped reservoir out of a piece of your intestine. This reservoir, often called a neobladder, sits inside your body and is attached to your urethra. The neobladder allows most people to urinate normally. A small number of people difficulty emptying the neobladder and may need to use a catheter periodically to drain all the urine from the neobladder.
. Ileal conduit. For this type of urinary diversion, your surgeon creates a tube (ileal conduit) using a piece of your intestine. The tube runs from your ureters, which drain your kidneys, to the outside of your body, where urine empties into a pouch (urostomy bag) you wear on your abdomen.
. Continent urinary reservoir. During this type of urinary diversion procedure, your surgeon uses a section of intestine to create a small pouch (reservoir) to hold urine, located inside your body. You drain urine from the reservoir through an opening in your abdomen using a catheter a few times each day.
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Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination.
Chemotherapy drugs can be given:
. Through a vein (intravenously). Intravenous chemotherapy is frequently used before bladder removal surgery to increase the chances of curing the cancer. Chemotherapy may also be used to kill cancer cells that might remain after surgery. In certain situations, chemotherapy may be combined with radiation therapy.
. Directly into the bladder (intravesical therapy). During intravesical chemotherapy, a tube is passed through your urethra directly to your bladder. The chemotherapy is placed in the bladder for a set period of time before being drained. It can be used as the primary treatment for superficial bladder cancer, where the cancer cells affect only the lining of the bladder and not the deeper muscle tissue.
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Radiation therapy uses beams of powerful energy, such as X-rays and protons, to destroy the cancer cells. Radiation therapy for bladder cancer usually is delivered from a machine that moves around your body, directing the energy beams to precise points.
Radiation therapy is sometimes combined with chemotherapy to treat bladder cancer in certain situations, such as when surgery isn't an option or isn't desired.
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Immunotherapy is a drug treatment that helps your immune system to fight cancer.
Immunotherapy can be given:
. Directly into the bladder (intravesical therapy). Intravesical immunotherapy might be recommended after TURBT for small bladder cancers that haven't grown into the deeper muscle layers of the bladder. This treatment uses bacillus Calmette-Guerin (BCG), which was developed as a vaccine used to protect against tuberculosis. BCG causes an immune system reaction that directs germ-fighting cells to the bladder.
. Through a vein (intravenously). Immunotherapy can be given intravenously for bladder cancer that's advanced or that comes back after initial treatment. Several immunotherapy drugs are available. These drugs help your immune system identify and fight the cancer cells.
Targeted therapy drugs focus on specific weaknesses present within cancer cells. By targeting these weaknesses, targeted drug treatments can cause cancer cells to die. Your cancer cells may be tested to see if targeted therapy is likely to be effective.
Targeted therapy may be an option for treating advanced bladder cancer when other treatments haven't helped.
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In certain situations, people with muscle-invasive bladder cancer who don't want to undergo surgery to remove the bladder may consider trying a combination of treatments instead. Known as trimodality therapy, this approach combines TURBT, chemotherapy and radiation therapy.
First, your surgeon performs a TURBT procedure to remove as much of the cancer as possible from your bladder while preserving bladder function. After TURBT, you undergo a regimen of chemotherapy along with radiation therapy.
If, after trying trimodality therapy, not all of the cancer is gone or you have a recurrence of muscle-invasive cancer, your doctor may recommend a radical cystectomy.