Treatments for Bladder Cancer

Superficial Bladder Cancer
Superficial bladder cancer is that which has not invaded at all into the muscle. As noted above, the extent of disease is based mainly on the transurethral resection (TUR). Likewise, the primary treatment for superficial disease is the TUR. Since the cancer is superficial, all of the tumor may be able to be removed by the TUR. Although TUR is almost always used to treat superficial bladder cancers, bladder tumors will recur (grow back) in about 30% of cases after TUR. For this reason, other treatments may be used in addition to TUR. The most common treatment is a compound known as BCG. BCG is placed into the bladder several times over 1-2 months. BCG is often used in addition to TUR for patients with high grade tumors, large tumors, multiply recurrent superficial tumors, or tumors that invades into the lining of the bladder (T1 tumors). Though BCG is effective, it is not without side effects-causing bladder spasm and irritation, often with every instillation.

Muscle Invading Bladder Cancer
The standard of care in treating more advanced cancers may involve surgically removing the entire bladder in a procedure called a cystectomy. A large concern in performing this surgery is how to divert the urine so that the patient can still excrete it. In the past, this was done using an "ileal conduit", where the urine drained through a portion of the small intestine and out through the skin into a bag. More recently, techniques for bladder reconstruction have developed. This allows the ureters to be implanted into the newly created bladder and the urethra to lead out of the new bladder. These techniques may allow the patient to be continent and excrete urine normally. Often, chemotherapy may be used in addition to surgery, either before the surgery or after the surgery. Recent data has demonstrated that use of chemotherapy may prolong survival and decrease risk of cancer recurrence; chemotherapy usually consists of a drug called cisplatin, in combination with other drugs.
Sometimes, radiation and chemotherapy may be used to allow the patient to avoid cystectomy; this is referred to as a “bladder-sparing approach.” Regimens that have the best results all start with maximum resection of the bladder tumor via TUR, just like with superficial bladder cancers. The patient then starts a treatment course of radiation with chemotherapy (usually with the drug cisplatin) for 4-5 weeks. Patients are then reevaluated by a repeat cystoscopy to determine if the chemotherapy and radiation have caused the tumor completely disappear. If the tumor is no longer present by examination, further chemotherapy and radiation is given for an additional 2-3 weeks. This method has comparable survival rates to cystectomy and has the advantage of allowing the patient to keep his or her bladder. If tumor remains after chemotherapy and radiation, the patient may be advised to undergo cystectomy, despite efforts to avoid this. Cystectomy is performed for patients who do not have adequate response to chemotherapy and radiation in order to eliminate the cancer and reduce the risk of death from the cancer.. Even when patients do not need to undergo cystectectomy, they may experience significant side effects from radiation and chemotherapy. The most concerning of these are decreased bladder capacity (leading to more frequent urination), bladder spasm, chronic burning or pain with urination, and hematuria from the damage done by the chemotherapy and radiation.
In summary, there are different treatment methods available for bladder cancer. All have curative potential. As is true for many other sites of cancer, regimens have been developed that allow for a higher quality of life after the treatment is completed. The exact method of treatment should be chosen individually by the patient, after discussing it with a team of physicians adept at treating bladder cancer, to maximize chance of cure and adequate bladder function.