Treatment Options for Bladder Cancer
Specific treatment for bladder or urethral cancer will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- grade and stage of the cancer
- your tolerance of specific medicines, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Most individuals with bladder cancer have superficial and non-invasive tumors. Treatment for these tumors is often very effective with an excellent prognosis. The remainder of bladder cancers invade deep into the bladder wall and muscle. There is a greater risk for metastasis into other tissues in these cases. Depending on the extent, bladder cancers may be managed with a single therapy or combination of treatments.
Treatment may include:
- surgery
There are several surgical procedures used to treat bladder cancers. Usually, hospitalization and anesthesia are needed. These include:- transurethral resection - the surgeon inserts a cystoscope through the urethra into the bladder. Tissue containing cancer cells can be surgically removed or burned away with an electric current called fulguration.
- segmental cystectomy - removal of a small portion of the bladder that contains the cancerous tissue. This procedure is most effective when there is only a single site of cancer cells in the bladder.
- radical cystectomy - removal of the bladder, lymph nodes near the bladder, and any nearby organs that contain cancer cells. This procedure is usually used when there are multiple areas of cancerous cells in the bladder and there is metastasis to other sites. When the bladder is removed, a urostomy procedure is performed. This is a surgical procedure to create another opening for urine to drain. Women who have a radical cystectomy usually have their uterus, ovaries, and part of the vagina removed as well. The prostate gland and seminal vesicles are usually removed in men who have a radical cystectomy. Some patients may be eligible for neobladder reconstruction, performed by urologic surgeons at Stanford.
What is a Urostomy?
A urostomy is a surgical procedure to create a new opening for urine drainage. Usually, a small portion of the small intestine is used to make a tube for urine passage to the outside of the body. The opening of this tube is called a stoma. Urine empties into a small pouch or bag attached over the stoma outside the body. Another type of urostomy procedure creates an internal pouch called a continent reservoir. This pouch, often made from the small intestine, is located inside the abdominal wall. It is connected to the urethra or to a stoma. Individuals with a continent reservoir urostomy learn to drain their urine using a catheter, either through the urethra or the stoma.
- radiation therapy
Radiation therapy uses high-energy rays to kill or shrink cancer cells. Internal or external radiation, or both, may be used in the treatment of bladder cancer. With internal radiation, a radiation implant is placed into the bladder for a direct effect on cancer cells. External radiation uses a machine outside the body to direct rays at a broader area, - chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. Chemotherapy may be given internally by placing the drugs directly in the bladder, called intravesical chemotherapy. It may also be given systemically, to affect cancer cells throughout the body. - biological therapy
Biological therapy uses the body's own immune system to fight cancer. In one form of this therapy, a solution called Bacillus Calmette-Guerin (BCG) is placed in the bladder, where it stimulates the immune system to kill the cancer cells. - clinical trials
Clinical trials and research studies are underway to evaluate new therapies. Some of these include photodynamic therapy, which involves the use of light to kill cancer cells, and the use of interferon as an anticancer agent.
The long-term prognosis for individuals with bladder or urethral cancer depends on the size of the tumor, lymph node involvement, and degree of metastasis (spreading) at the time of diagnosis. Sometimes superficial bladder cancers recur locally in the bladder, at the site of original diagnosis, or at other places in the bladder. These recurrent tumors are evaluated and treated the same way as the original cancer. However, if the tumor continues to return, eventually a cystectomy will be required. But, tumors that recur in distant sites may require other treatments, such as chemotherapy or radiation therapy.
Trial Administration