The following is the summary of the interventions that are being generally considered to treat bladder cancer patients:
TURBT – this is the endoscopic resection of your bladder done to confirm the diagnosis of bladder cancer, as well as the definitive treatment for superficial bladder cancers.
Immunotherapy – Bacillus Calmette-Guerin (BCG), a bacteria of low pathogenic potential, is used for treating high grade and aggressive superficial bladder cancer. A catheter is used to administer BCG directly into the bladder, which in turn activates the body’s immune system. Activated immune cells then attack and destroy cancer cells. Symptoms associated with this immune therapy include, but are not limited to fever, cold, and fatigue.
Intravesical Chemotherapy – This is used in low grade and intermediate grade superficial bladder cancers. Chemotherapy is instilled into the bladder as an adjuvant therapy after TURBT, and then followed by weekly therapy for 6 weeks. There are hardly any side effects by instilling this into the bladder as compared to the regular IV (intravenous) chemotherapy.
Radical cystectomy – this surgical procedure includes removal of the entire bladder, adjacent lymph nodes, and a part of the urethra done for muscle-invasive bladder cancers. During surgery, the prostate can also be removed in men, and in women, the uterus, fallopian tube, ovaries, and vaginal wall can be removed.
Pelvic lymph node dissection – this procedure is used to check for lymph node spread.
Radiation therapy – it is a post-operative treatment strategy that is performed together with chemotherapy. It uses high-energy beams of radiation to destroy cancer cells. Common side-effects related to this therapy are nausea, vomiting and diarrhea.
Neoadjuvant chemotherapy – it is usually performed together with cystectomy. In chemotherapy, an anti-cancer drug or a combination of drugs is administered intravenously to kill cancer cells and reduce the size of the tumor, prior to surgery. This therapy comes with many side-effects, including reduced appetite, nausea, vomiting, hair loss, reduced blood cell count, infection, weakness and fatigue, and numbness in the hands and feet, among others. However, the best way to achieve cure is to have neo-adjuvant chemotherapy before bladder removal. It is best you discuss these issues with your urologist.
Summary of treatment modalities for bladder cancer
Superficial bladder cancer
Transurethral resection of bladder tumor (TURBT) – is a very important technique to determine the type, stage, and grade of bladder cancer. This procedure is performed to see inside the bladder, take tumor sample, and resect the tumor from the bladder wall. This is followed by intravesical chemotherapy or BCG
Muscle-invasive bladder cancer
The golden standard for treating muscle-invasive bladder cancer is radical cystectomy with extended pelvic lymph node dissection, with or without chemotherapy.
Advanced bladder cancers
May be treated with chemotherapy, a number of targeted agents, in particular the checkpoint inhibitors.