Bladder Cancer

How is bladder cancer treated?

The type of treatment recommended for bladder cancer depends on the grade and stage of the cancer. Treatment generally involves surgery to remove the cancerous tissue (transurethral resection). Removal of the bladder may be necessary if the cancer is more advanced. In cases where the bladder is removed, reconstruction is needed to create a new way for urine to exit the body. 

Chemotherapy or radiation therapy may be recommended. Chemotherapy involves administering a drug or combination of drugs to kill the cancer cells or control their growth. Radiation therapy uses powerful, focused beams of energy to kill cancer cells. A combination of treatments, e.g. surgery + chemotherapy or surgery + radiation therapy or a combination of all three may be recommended to treat bladder cancer. In some cases, immunotherapy may be recommended to trigger the body’s immune system to fight the cancer cells. 

Bladder cancer surgery

Non-muscle invasive bladder cancer is usually treated by: 

• Transurethral resection of bladder tumour (TURBT). Under anaesthesia, the surgeon uses an instrument called a resectoscope inserted through the penis to remove the tumour tissue one piece at a time, using a special wire loop. The pieces of tissue are flushed out at the end of the operation. 
• Intravesical therapy. After surgical resection, chemotherapy agents such as mitomycin or immunotherapy such as BCG (Bacille Calmette Guerin) therapy may be given through a catheter into the bladder to reduce the risk of recurrence and disease progression. Immunotherapy uses substances made by the body or in a laboratory to boost, direct, or restore the body’s natural defenses against cancer. 

Muscle-invasive bladder cancer which has a high chance of spreading to other parts of the body is usually aggressively treated by: 

• Surgery which involves removal of the entire bladder (radical cystectomy). Under general anaesthesia, the surgeon removes the entire urinary bladder and the surrounding lymph nodes in the pelvis. The prostate is removed in males. And in females, the uterus, ovaries, fallopian tubes and part of the vagina is removed. When the entire bladder is removed, the ureters are disconnected from the bladder and joined to a loop of small intestines specially fashioned to contain urine. Depending on the patient’s pre-operative medical condition and stage of disease, the loop of small intestine may be connected directly to the abdominal wall for urine to flow out through a urinary stoma (ileal conduit) or fashioned into a sphere (ileal neobladder) and reattached to the urethra so that urine passes out through the normal passage. Some patients may need to catheterise their urine passage regularly every day to empty the bladder, as the neobladder does not have the sensory and contractile properties of the native bladder. 
• Radiation therapy is used to treat the cancer by using high-energy x-rays to kill cancer cells or keep them from growing. 

Sometimes a combination of treatment with chemotherapy with surgery or radiation is needed to improve the chances of cure in patients with advanced bladder cancer.