People with bladder cancer have many treatment options. They may have surgery, radiation therapy, chemotherapy or biological therapy. Some patients get a combination of therapies.
Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. The doctor can explain each type of surgery and discuss which is most suitable for the patient.
Transurethral Resection (TUR) may be used to treat early (superficial) bladder cancer. During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and to burn away any remaining cancer cells with an electric current.
Radical Cystectomy is the most common type of surgery for invasive bladder cancer. The doctor also chooses this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are removed.
Segmental Cystectomy is used in cases to remove only part of the bladder. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.
Radiation Therapy uses high-energy radiation to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.
A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may resurface in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.
Doctors use two types of radiation therapy to treat bladder cancer:
External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated five days a week for five to seven weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants.
Internal Radiation: A small container of a radioactive substance is placed into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during the treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body.
Chemotherapy uses drugs to kill cancer. The doctor may use one drug or a combination of drugs.
For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.
Chemotherapy attacks the cells lining the inside o the bladder.
Immunotherapy causes the patient's own body to attack the cells lining the inside of the bladder.
Intravesical Chemotherapy is often done with Thiotepa or Mitomycin C.
If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through the vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.
The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay.