What are the Treatments for Bladder Cancer?

The choice of treatments depends on a number of factors, including 

• your age, 
• risk of bladder cancer,
• previous treatment,
• general health and 
• the extent and stage of the tumour. 

There are a number of possible treatments available to patients diagnosed with bladder cancer. These include:

Non-Surgical Approaches:

A number of treatments may be used in conjunction with each other, typical examples being the use of 

• Intravesical therapies such as BCG or Chemotherapy (see chemo information), 
• Pre-operative (neoadjuvant) chemotherapy or immunotherapy to shrink the tumour or slow its growth in case of muscle-invasive bladder cancer,
• Radiotherapy (in the setting of muscle-invasive bladder cancer in a combination of maximal TURBT and chemotherapy especially if radical cystectomy is deemed to be risky or patient preference or if symptomatic for palliation)

Surgical Approaches:

• Transurethral Resection of the Bladder Tumour (TURBT)
• Radical Cystectomy
• Urinary Diversion

Dr Hadley will discuss with you to ascertain the most appropriate course of treatment for you.

Surgical Treatments for Bladder Cancer

Bladder cancers that have grown into surrounding tissue usually require surgical therapy. 

Tumours that have invaded the muscle or tissue around the bladder need surgical management.

Transurethral Resection of the Bladder Tumour (TURBT)

Transurethral Resection of the Bladder Tumour involves the inserting a thin tube, through the urethra and up into the bladder. The surgeon can then remove the tumour without the need for a large external incision. 

Radical Cystectomy

A standard form of surgery for muscle-invasive bladder cancer is a Radical Cystectomy, which involves cutting away the entire bladder and associated tissues (including prostate in men), with Pelvic Lymphadenectomy (removal of the lymph nodes within the hip cavity). Radical cystectomy in women often includes removal of the uterus, Fallopian tubes, ovaries, anterior vaginal wall (the front of the birth canal), and urethra but can be spared with the aim of preserving sexual function.

In men, it is also called a Cysto-Prostatectomy, as it involves the removal of the bladder and prostate, with Pelvic Lymphadenectomy.

Urinary Diversion

The body regulates its internal metabolites bypassing the blood through the kidneys, which then filter the blood and pass the wastes through the ureters into the bladder. This wasted is then discharged from the body in the form of urine.

Because some types of cancer can only be remedied by removing the bladder, another way must be found in order for the body to discharge urine. These procedures are called urinary diversion.

The most common diversion is called an Ileal Conduit – this involves taking a piece of bowel and forming a ‘pipe’ that is inserted where the bladder once was. The conduit then carries the urine from the ureters out onto the skin of the abdomen where the conduit ends in a Stoma – a small opening. Urine is then emptied into a plastic bag attached to the skin, where it can be emptied at various intervals.

Other forms of diversion involve the formation of an internal pouch made out of part of the bowel. The pouch has an inbuilt valve so that urine collects inside and does not leak through the Stoma. When it needs emptying, a small plastic tube called a catheter can be passed through the stoma and the valve allowing urine to flow out. 

This is a major piece of surgery and requires much planning and recuperation time. The suitability of this procedure should be discussed with Dr Hadley.

Non-Surgical Treatment for Bladder Cancer

Intravesical Treatment

Intravesical treatment involves flushing the bladder with chemotherapy or immunotherapy to flush out any residual tumour cells following surgery. These drugs are placed directly into the bladder in order to prevent the tumour from recurring or to prevent it from invading the deeper layers of the bladder wall. 

Researchers have trialled various combinations of systemic drugs and a number of these have proven efficacy in the adjuvant treatment of bladder cancers.

Radiotherapy for Bladder Cancer

What is Radiation Therapy?

Radiotherapy uses powerful x-rays and other high-energy rays to kill cancer cells using a machine called a ‘Linear Accelerator’. Damaging the cancer cells means that they cannot grow or multiply and so they die. Normal cells are also damaged in this procedure but usually recover.

During treatment planning, the radiation oncologist uses all the information gathered to develop an individual treatment plan.

Who gets Radiation Therapy?

A number of tests will be performed in order to allow doctors to determine the best course of treatment for the type of cancer for each individual. The tests include a cystoscopy and a CT scan to assess the extent of the tumour present. It is also based on patient symptoms, preference and the aim of the treatment (ie curative or palliative).

The above information will help doctors to determine whether radiation therapy is solely used or whether it can be used in conjunction with other treatments (ie chemotherapy). An accurate radiation dose to your cancer can be calculated while limiting the radiation to the surrounding areas such as the rectum.

What are the Side Effects?

The x-rays used during radiation therapy may damage normal body cells as well as cancer cells, although healthy cells usually recover from the damage. The incidence and severity of any side effects vary from patient to patient and may include

• Tiredness or fatigue
• Bladder irritation, cramps or painful urination/blood in the urine
• Diarrhoea and Bowel Cramps
• Proctitis or pain in the rectum/bleeding
• Vaginal discomfort

A variety of measures can be taken to alleviate these symptoms, discuss these issues with your doctor and radiation therapy team for the best advice for each individual.

What if Bladder Cancer is Untreated?

Untreated bladder cancer produces significant morbidity, including the following:

• Haematuria
• Dysuria (burning sensation on urination) or Irritative urinary symptoms
• Urinary retention or incontinence
• Upper urinary tract/Ureteric obstruction or kidney failure
• Pelvic or bone pain
• Constitutional symptoms (Fatigue, anorexia, weight loss)

The prognosis is poor especially if patients with muscle-invasive bladder cancer are not treated. Most patients will have significant morbidity and will die from the disease within a few years of diagnosis.