Therapy is based on the stage of the cancer, prognosis, other health problems, and the patient's wishes. It's critical to know the stage of cancer and the grade of the tumor. Staging ranges from early-stage disease to stage IV bladder cancer, which means the cancer cells have already spread to distant sites in the body. The stage of disease impacts bladder cancer survival rates.
Some patients' cases are discussed at Wilmot's multidisciplinary tumor board — a conference that is attended by all different specialties required for your care.
Four types of treatment are commonly used for bladder cancer: surgery, chemotherapy, radiation, and biologic or immune therapy.
A transurethral resection of bladder tumor (TURBT) is not only done to diagnose bladder cancer but can also be used to treat some cases of superficial, early-stage disease. Other types of surgery for invasive bladder cancer include:
Partial cystectomy: A surgeon removes part of the bladder and nearby lymph nodes, and closes the hole in the bladder. Although part of the bladder remains intact, it is smaller and the patient will need to urinate much more often.
Radical cystectomy: A surgeon removes the bladder, nearby lymph nodes, and perhaps other nearby organs if the cancer has begun to spread. The surgeon also performs a urinary diversion, a procedure that creates another way for the body to store and get rid of urine.
Reconstructive surgeries: These are possible following a radical cystectomy. They include: incontinent or continent diversions, which involve creating a stoma or an opening on the abdomen to pass urine; or creating a new bladder using pieces of the intestinal tract and bringing the substitute bladder to the urethra so that voiding can occur naturally.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and to eradicate cancer cells. External beam radiation can be combined with chemotherapy to treat some patients with muscle-invading bladder cancer.
Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. It can be used before or after surgery to treat bladder cancer. Several drugs can be used either alone or in various combinations. Because of the bladder's location, chemotherapy can be placed directly into the bladder to treat some superficial cancers.
Biologic or immunotherapy
This type of therapy uses a patient’s own immune system to fight cancer. For early-stage bladder cancer, doctors can place medicines directly into the bladder, which is known as intravesical immunotherapy. Another, newer type of immunotherapy uses a germ related to the tuberculosis (Bacillus Clamette-Guerin), which is delivered into the bladder through a catheter. The body’s own immune cells rush to the bladder after being activated by the TB germ and begin fighting cancer. In cases of more advanced cancer, immune therapy is being actively studied in clinical trials at Wilmot and is showing promising results.
Bladder cancer surgery can have a big impact on your life. Much like any surgery there are significant risks. In addition, patients who have a radical cystectomy and reconstructive surgery may need to learn how to use a urostomy bag, how to place a catheter into a stoma to release urine, or re-learn voiding control. Bladder cancer surgery also impacts mens’ and womens’ sexual function.