If you are diagnosed with bladder cancer, it is normal to feel very scared and anxious about it. But remember, there are now many effective treatments for this. In this article, we will talk about those treatment options. Your doctor will definitely help you decide which treatment is best for you.
Choosing the best treatment for you depends on several factors , including your age, how far the cancer has spread (this is what doctors call the "stage" of the cancer), and other health conditions you have .
How to detect the spread of cancer
Simply put, the way cancer has spread can be divided into three main categories:
- Superficial cancer: This means that the cancer has not spread to the muscle layer of your bladder wall. This means that it is only in the superficial layers.
- Muscle-invasive cancer: Here, cancer cells have spread to the muscle layer of the bladder.
- Advanced or Metastatic: This is an advanced stage where the cancer has spread beyond the bladder, to nearby lymph nodes, or to other organs, such as the lungs.
Most people with bladder cancer need surgery. But sometimes surgery alone may not be able to completely remove the disease. In that case, other treatments may be used along with or instead of surgery. For example , chemotherapy, radiation, and immunotherapy are used.
TURBT surgery
The most common surgery for early-stage bladder cancer is called a transurethral resection of bladder tumor (TURBT). The full name for this is Transurethral Resection of Bladder Tumor. In this procedure, doctors take tissue samples from inside your bladder to check for cancer and whether it has spread. Or, they may use this procedure to remove the tumor.
Before this surgery, you may have a blood test and a chest X-ray to see if you are in a good health condition for it. However, during this surgery , no cuts are made in your skin. The doctor enters your bladder through your urethra, the tube through which urine comes out.
Before surgery, you will be given either general anesthesia, which puts you completely to sleep, or regional anesthesia, which numbs only the lower part of your body.
The doctor then uses a special instrument called a cystoscope. This is a thin, long, flexible tube. At the end of it is a camera, a light, and a small instrument that can cut and remove the cancer. This is passed through the urethra into the bladder, and the camera is used to look inside the bladder. In this way, the cancer or tissue is removed, and heat is applied to stop the bleeding.
The tissue samples removed in this way are sent to a lab and examined under a microscope to see if they contain cancer cells.
After surgery, a tube called a catheter will be placed in your bladder. This will drain urine into a bag. You may need to keep this in place for a few days. This may feel a little uncomfortable after the anesthesia wears off. Men may sometimes experience pain at the tip of their penis. If this happens, tell your doctor or nurse. A numbing gel can be used to help.
Most people go home the same day of surgery. However, if the tumor is large, you may need to stay in the hospital overnight. You may notice some blood in your urine for about three days after surgery. Drink at least 8-10 glasses of water a day to flush out your bladder. This can also help prevent infections.
Cystectomy surgery
During this surgery, the doctor removes part of your bladder (`Partial Cystectomy`) or your entire bladder (`Radical Cystectomy`).
- Partial Cystectomy: This surgery can be performed if the cancer has spread to the muscle layer of the bladder but is still small.
- Radical Cystectomy: If the cancer is large or has spread to several areas of the bladder, the doctor will remove the entire bladder and surrounding lymph nodes. If the cancer has spread further, the surrounding reproductive organs may also be removed.
- In women: the uterus, cervix, part of the vagina, ovaries, and fallopian tubes may be removed.
- In men: The prostate gland and seminal vesicles may be removed.
You will be anesthetized for this surgery, so you will not feel any pain. You will stay in the hospital for about a week after the surgery. You will be able to return to normal life in a few weeks.
Other main treatments
In addition to surgery, there are several other very important and successful treatment methods.
| Treatment method | Simply put... |
|---|---|
| BCG treatment | This is also a type of immunotherapy. A liquid containing the germ Bacillus Calmette-Guerin (BCG) (a type of bacteria that causes tuberculosis, but does not cause disease) is injected into the bladder through a catheter. This causes the body's immune cells to enter the bladder and begin fighting the cancer cells. |
| Intravesical chemotherapy | Chemotherapy is administered directly into the bladder through a catheter to kill cancer cells. This is used if BCG treatment is not successful. |
| Systemic Chemotherapy | These are medications given through a vein (IV) or as pills. They travel through the bloodstream throughout the body, killing cancer cells that have spread beyond the bladder. They are given in several treatment cycles. |
| Radiation Therapy | This treatment uses high-energy rays, such as powerful X-rays, to destroy cancer cells. It is painless. It may take several weeks, about 5 days a week. |
| Chemoradiotherapy | To avoid surgery to remove the bladder, both chemotherapy and radiation therapy are given together. |
The latest and most advanced treatments
With the advancement of medical science, more modern treatments for bladder cancer have emerged.
Immunotherapy
What this does is use your own immune system to attack cancer. Think of it like our immune cells have 'checkpoints'. These are the places that help us identify normal cells and the enemies we need to fight. Cancer cells are very cunning, they connect to these checkpoints and trick the immune system into thinking, 'I'm one of yours, don't attack me.' So what these ``Checkpoint Inhibitor`` drugs do is stop that trickery. Then the immune system can recognize and attack cancer cells. Some examples are drugs like ``Atezolizumab``, ``Nivolumab``, ``Pembrolizumab``.
Targeted Therapy
This involves giving drugs that target specific genetic changes (gene changes) found only in cancer cells. This results in less damage to healthy cells. An example is a class of drugs called FGFR inhibitors.
Gene Therapy
This is a new treatment using gene technology. It may be suggested for some patients who have not been successful with BCG treatment. Drugs like `Nadofaragene firadenovec (Adstiladrin)` work by inserting a cancer-fighting gene directly into the bladder and stimulating the body's immune system.
Important: Discussing all of these treatments, their pros, cons, and side effects, openly with your doctor is essential to deciding what is best for you.
Shall we also learn about clinical trials?
Scientists and doctors are constantly researching new, more effective drugs and treatments for bladder cancer. These new treatments need to be tested for safety and effectiveness before they are given to patients. This type of research is called a clinical trial.
Some patients are afraid to get involved, thinking that they will not receive any treatment. But in reality, in a clinical trial, a patient receives the best standard treatment available, or an even better treatment that may be available in the future. This is the only way to find out if a new treatment is better than existing treatments.
"Always ask your oncologist about clinical trial opportunities," the expert advises. "That's the best way to find out about the latest treatments."
Take-Home Message
- If you are diagnosed with bladder cancer, don't panic and work with your doctor to find the treatment option that best suits you.
- The treatment method depends on factors such as your age, the stage of the cancer (how far it has spread), and your overall health.
- The most commonly used treatment for early-stage cancer is TURBT surgery.
- In addition, there are many other successful treatment options, such as cystectomy, chemotherapy, radiation therapy, immunotherapy, targeted therapy, and gene therapy.
- Don't hesitate to ask your doctor about the latest treatments and clinical trials.
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