Bladder Cancer Treatment- Cancer/Oncology

KEY POINTS

• There are different types of treatment for patients with bladder cancer.
• Four types of standard treatment are used:
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Immunotherapy
• New types of treatment are being tested in clinical trials.
• Treatment for bladder cancer may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.
• Follow-up tests may be needed.

There are different types of treatment for patients with bladder cancer.

Different types of treatment are available for patients with bladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Four types of standard treatment are used:

Surgery

One of the following types of surgery may be done:

• Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
• Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficialcancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostateand the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
• Partial cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery. This is also called segmental cystectomy.
• Urinary diversion: Surgery to make a new way for the body to store and pass urine.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat bladder cancer.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavitysuch as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). For bladder cancer, regional chemotherapy may be intravesical (put into the bladder through a tube inserted into the urethra). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment using more than one anticancer drug.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

There are different types of immunotherapy:

• Immune checkpoint inhibitor therapy: PD-1 inhibitors are a type of immune checkpoint inhibitor therapy used in the treatment of bladder cancer. PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. Pembrolizumab, atezolizumab, nivolumab, avelumab, and durvalumab are types of PD-1 inhibitors.
• BCG (bacillus Calmette-Guérin): Bladder cancer may be treated with an intravesical immunotherapy called BCG. The BCG is given in a solution that is placed directly into the bladder using a catheter (thin tube).
• See Drugs Approved for Bladder Cancer for more information.

Treatment Options by Stage

• Stage 0 (Noninvasive Papillary Carcinoma and Carcinoma in Situ)
• Stage I Bladder Cancer
• Stages II and III Bladder Cancer
• Stage IV Bladder Cancer

Stage 0 (Noninvasive Papillary Carcinoma and Carcinoma in Situ)

Treatment of stage 0 (noninvasive papillary carcinoma and carcinoma in situ) may include the following:

• Transurethral resection with fulguration. This may be followed by one of the following:
  • Intravesical chemotherapy given right after surgery.
  • Intravesical chemotherapy given right after surgery and then regular treatments with intravesical BCGor intravesical chemotherapy.
• Partial cystectomy.
• Radical cystectomy.
• A clinical trial of a new treatment.

Stage I Bladder Cancer

Treatment of stage I bladder cancer may include the following:

• Transurethral resection with fulguration. This may be followed by one of the following:
  • Intravesical chemotherapy given right after surgery.
  • Intravesical chemotherapy given right after surgery and then regular treatments with intravesical BCGor intravesical chemotherapy.
• Partial cystectomy.
• Radical cystectomy.
• A clinical trial of a new treatment.

Stages II and III Bladder Cancer

Treatment of stages II and III bladder cancer may include the following:

• Radical cystectomy.
• Combination chemotherapy followed by radical cystectomy. A urinary diversion may be done.
• External radiation therapy with or without chemotherapy.
• Partial cystectomy with or without chemotherapy.
• Transurethral resection with fulguration.
• A clinical trial of a new treatment.

Stage IV Bladder Cancer

Treatment of stage IV bladder cancer that has not spread to other parts of the body may include the following:

• Chemotherapy.
• Radical cystectomy alone or followed by chemotherapy.
• External radiation therapy with or without chemotherapy.
• Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.

Treatment of stage IV bladder cancer that has spread to other parts of the body, such as the lung, bone, or liver, may include the following:

• Chemotherapy with or without local treatment (surgery or radiation therapy).
• Immunotherapy (immune checkpoint inhibitor therapy).
• External radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
• Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of new anticancer drugs.

Treatment of recurrent bladder cancer depends on previous treatment and where the cancer has recurred. Treatment for recurrent bladder cancer may include the following:

• Combination chemotherapy.
• Immunotherapy (immune checkpoint inhibitor therapy).
• Surgery for superficial or localized tumors. Surgery may be followed by biologic therapy and/or chemotherapy.
• Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.

To learn more about Bladder Cancer Treatment, please check our blog on BLADDER CANCER: KNOW THE BASICS.

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