How Cancer Of The Bladder Is Treated
There are treatments for all patients with cancer of the bladder. Four kinds of treatment are used: surgery (taking out the cancer in an operation) radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors) chemotherapy (using drugs to kill cancer cells) biological therapy (using the body's immune system to fight cancer).
Bladder Cancer Picture
A new type of treatment called photodynamic therapy is being tested in clinical trials.
Surgery is a common treatment for cancer of the bladder. Your doctor may take out the cancer using one of the following operations:
Transurethral resection is an operation that uses a cystoscope inserted into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer or to burn the tumor away with high-energy electricity (fulguration).
Segmental cystectomy is an operation to take out the part of the bladder where the cancer is found. Because bladder cancer often occurs in more than one part of the bladder, this operation is used only in selected cases where the cancer is in one area.
Cystectomy is an operation to take out the bladder.
Radical cystectomy is an operation to take out the bladder and the tissue around it. In women, the uterus, ovaries, fallopian tubes, part of the vagina, and urethra are also removed. In men, the prostate and the glands that produce fluid that is part of the semen (seminal vesicles) are also removed, and the urethra may be removed as well. The lymph nodes in the pelvis may also be taken out (pelvic lymph node dissection).
Urinary diversion is an operation to make a way for urine to pass out of the body so that it does not go through the bladder. It is used to relieve bladder symptoms when the tumor has spread.
If your bladder is removed, your doctor will need to make a new way for you to store and pass urine. There are several ways to do this. Sometimes your doctor will use part of the small intestine to make a tube through which urine can pass out of the body through an opening (stoma) on the outside of the body. This procedure is sometimes called an ostomy or urostomy.
If you have an ostomy, you will need to wear a special bag to collect urine. This special bag, which sticks to the skin around the stoma with a special glue, can be thrown away after it is used. The bag does not show under clothing and most people take care of these bags themselves. The doctor may also use part of your small intestine to make a new storage pouch (a continent reservoir) inside the body where urine can collect. You would then need to use a tube (catheter) to drain the urine through the stoma. Newer methods use a part of the small intestine to make a new storage pouch that is connected to the remaining part of the urethra if it has not been removed. Urine then passes out of the body through the urethra, and a stoma is not necessary.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put in the body through a needle inserted into a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the bladder. Chemotherapy may also be given in a fluid that is put into the bladder through a tube going through the urethra (intravesical chemotherapy).
If your doctor removes all the cancer that can be seen at the time of the operation, you may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be seen is called adjuvant chemotherapy. For bladder cancer, chemotherapy is sometimes given before surgery to try to improve results or to preserve the bladder. Chemotherapy given in this manner is called neoadjuvant chemotherapy. Neoadjuvant chemotherapy is being carefully studied in a clinical trial sponsored by the National Cancer Institute.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
Biological therapy tries to get your body to fight cancer. It uses materials made by your body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. Biological therapy may be given in a fluid that is put into the bladder through a tube going through the urethra (intravesical biological therapy).
Photodynamic therapy is a new type of treatment that uses special drugs and light to kill cancer cells. A drug that makes cancer cells more sensitive to light is put into the bladder, and a special light is used to shine on the bladder. This therapy is being studied for early stages of bladder cancer.
