Bladder cancer treatment has advanced significantly, offering patients a variety of options depending on the stage and type of cancer. Each treatment approach aims to remove or destroy cancer cells while preserving bladder function as much as possible. This blog will discuss the primary treatment options for bladder cancer, including surgery, chemotherapy, radiation therapy, and the latest advancements in immunotherapy and targeted therapies.
Surgical Treatments
- Transurethral Resection of Bladder Tumor (TURBT)
- Purpose: TURBT is commonly used for diagnosing, staging, and treating early-stage bladder cancer.
- Procedure: A cystoscope is inserted through the urethra to reach the bladder, where the surgeon uses a wire loop to remove cancerous tissues or burn them with a laser.
- Recovery: This is typically an outpatient procedure with a quick recovery time.
- Radical Cystectomy
- Purpose: Recommended for muscle-invasive bladder cancer or high-risk non-muscle invasive cancers.
- Procedure: The entire bladder, nearby lymph nodes, and part of the urethra are removed. In men, the prostate may also be removed, while in women, the uterus, ovaries, and part of the vagina might be excised.
- Reconstruction: Post-surgery, urinary diversion techniques such as an ileal conduit, continent reservoir, or neobladder are used to reroute urine flow.
- Partial Cystectomy
- Purpose: Suitable for patients with a single, isolated tumor that hasn’t spread.
- Procedure: Only a portion of the bladder containing cancer is removed.
- Recovery: This allows patients to retain more bladder function compared to a radical cystectomy.
Chemotherapy
- Intravesical Chemotherapy
- Purpose: Used for non-muscle invasive bladder cancer to prevent recurrence after TURBT.
- Procedure: Chemotherapy drugs are delivered directly into the bladder via a catheter.
- Common Drugs: Mitomycin, thiotepa, and doxorubicin.
- Systemic Chemotherapy
- Purpose: Used for muscle-invasive or metastatic bladder cancer.
- Procedure: Chemotherapy drugs are administered orally or intravenously to reach cancer cells throughout the body.
- Common Regimens: Cisplatin-based combinations like MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or gemcitabine and cisplatin.
Radiation Therapy
- Purpose: Often combined with chemotherapy (chemoradiation) for muscle-invasive bladder cancer or for patients who are not candidates for surgery.
- Procedure: High-energy radiation beams are directed at the bladder to destroy cancer cells.
- Application: Can be used as a primary treatment, post-surgery to eliminate residual cancer cells, or to alleviate symptoms in advanced cancer stages.
Immunotherapy
- Intravesical Immunotherapy
- Purpose: Primarily used for non-muscle invasive bladder cancer.
- Procedure: Bacillus Calmette-Guérin (BCG) vaccine is introduced directly into the bladder.
- Mechanism: Stimulates the immune system to attack cancer cells within the bladder.
- Systemic Immunotherapy
- Checkpoint Inhibitors: These drugs block proteins that prevent the immune system from attacking cancer cells.
- Common Drugs: Pembrolizumab (Keytruda), atezolizumab (Tecentriq), nivolumab (Opdivo), durvalumab (Imfinzi), and avelumab (Bavencio).
- Purpose: Used for advanced or metastatic bladder cancer that has not responded to chemotherapy.
Targeted Therapy
- Purpose: Targeted therapies focus on specific molecules or pathways crucial for cancer cell growth and survival.
- Common Drugs: Erdafitinib (Balversa) targets FGFR genetic alterations.
- Application: Suitable for patients with specific genetic mutations identified through molecular testing.
Conclusion
Bladder cancer treatment has evolved, providing multiple options tailored to the cancer’s stage and patient health. Surgery, chemotherapy, and radiation therapy remain mainstays, while advancements in immunotherapy and targeted therapies offer new hope, especially for advanced cases. Collaboration between patients and healthcare providers is crucial to determine the most effective treatment plan. Regular follow-ups and monitoring are essential to manage the disease and maintain quality of life. If you or a loved one is facing bladder cancer, consult with a specialized medical team to explore the best treatment options available.
