Bladder Cancer Treatment
The right treatment for bladder cancer depends on how far the tumor has penetrated the wall of the bladder. Cancers on the surface of the bladder lining and cancers that have not spread far into the bladder wall can largely be managed using minimally invasive techniques. The deeper the cancer has spread into the bladder wall, the greater the need for aggressive therapy.
Non-Invasive Bladder Cancer
About 80 percent of bladder tumors have not yet penetrated the muscle layer of the bladder wall. The earliest of these cancers are confined to the surface of the bladder lining and are almost like warts inside the bladder. An intermediate group of bladder cancers are tumors that have started to penetrate the bladder wall but have not yet reached the muscle layer.
These non-invasive tumors are treated using minimally invasive procedures. An endoscope is carefully inserted into the urethra and guided to the bladder. Using special instruments, the physician scrapes the tumor off the bladder wall. (The tissue is sent to pathology to determine the grade and stage of the cancer.) In some cases, the physician will apply a chemotherapy drug directly to the site to help prevent recurrence of the cancer. Some patients may undergo repeated endoscopic applications of the drug over an extended period.
This treatment approach is very effective for non-invasive bladder cancers. About 95 percent of patients with these early-stage tumors experience a long-term cure.
Muscle-Invasive Bladder Cancer
Tumors that have penetrated the muscle layer of the bladder put the patient in a much higher risk group. For these patients, treatment aims at preventing the cancer from spreading to other organs.
- Cystectomy: The standard treatment for muscle-invasive bladder cancer in the United States is surgical removal of the bladder (cystectomy) coupled with surgical reconstruction (see below). For many patients, cystectomy also includes removal of lymph nodes and other nearby organs. Select patients are eligible for a robot-assisted cystectomy, a less invasive technique that can result in faster recovery.
- Chemotherapy before surgery: Bladder cancer is relatively chemo-sensitive. When a tumor has invaded the muscle layer of the bladder, giving chemotherapy prior to bladder removal improves survival rates. A combination of agents is used to shrink the tumor, increasing the chance that the surgeon will be able to remove all of the diseased tissue and reducing the chance of the cancer spreading outside the bladder.
- Chemotherapy after surgery: Patients who have had the bladder surgically removed (and have not yet received chemotherapy) can benefit from post-surgery drug therapy. A combination of chemotherapy agents has been shown to improve outcomes for patients with higher-risk disease.
- Radiation therapy: Some cystectomy patients also receive external beam radiation therapy and/or brachytherapy radiation to help kill cancer cells that remain following surgery.
- Radiation therapy and chemotherapy to spare the bladder (organ preservation) is another option for muscle invasive bladder cancer. This is a non-surgical approach, and for well-selected cases, offers a good chance for curing the cancer and keeping good bladder function. Froedtert & the Medical College offer an excellent team approach for coordinating this option for bladder cancer patients.
- Partial cystectomy: Certain patients with muscle-invasive bladder cancer are eligible for an organ-sparing approach that combines surgical removal of the tumor with radiation and drug therapy. In this treatment approach, the bladder tumor is removed using endoscopic instruments inserted through the urethra. Then, over the course of several weeks, the patient receives a combination of chemotherapy and external beam radiation therapy. Typical side effects include loose stool, frequent urination and some suppression of the immune system, all of which resolve eventually.
Bladder removal (in combination with other appropriate therapies) can lead to long-term cure for approximately 60 percent of patients with muscle-invasive bladder cancer.
Metastatic Bladder Cancer
Bladder cancer can spread to other parts of the body. When this disease metastasizes, it can cause pain and result in functional impairments.
- Radiation therapy for pain control: Radiation therapy can reduce pain by shrinking painful bone metastases. Options include external beam radiation or the injection of a radioactive drug that collects in bone tissue. In some instances, metastases to the spine can put pressure on the spinal cord, resulting in impaired arm or leg movement. Shrinking these metastases can help restore physical function.
- Drug therapy for metastatic disease: Several drug regimens are able to extend survival for patients with bladder cancer that has spread to other parts of the body. There are also several chemotherapy clinical trials available for patients with metastatic bladder cancer.