Bladder Cancer Treatment Options - OmniMedicalSearch.com

Conditions & Diseases: Cancers

Bladder Cancer

Treatment Options

There are several type of treatment available for bladder cancer patients. The treatment varies from patient to patient and takes in consideration certain factors: (1) the tumor type and size, (2) the cancer stage, (3) the cancer extant (how far the cancer has spread) (4) the general health state of the patient, and (5) the patient’s age.

The treatment options for bladder cancer patients include: surgery, chemotherapy, biological therapy, radiation therapy, and photodynamic therapy.

Surgery
There are five types of surgeries that can be performed in patients with bladder cancer:

1. Transurethral resection (TUR): This is a type of surgery where the tumor is removed with a small wire loop while any remaining cancerous cells are burned with an electric current. In some cases, instead of a wire loop, the doctor uses a high-energy laser to remove the tumor.

TUR is used in patients with superficial bladder cancer. The main side effect of this surgery is blood in the urine or pain when during urination for several days after the procedure. In most cases, patients that undergo a TUR surgery need to perform a cytoscopy test every 3 to 6 months, because superficial bladder cancer tends to recur.

2. Segmental cystectomy: This is a type of surgery where part of the bladder is removed together with the tumor. Segmental cystectomy is performed in patients with low-grade tumors that had invaded the bladder wall, but the cancer is confined to one portion of the bladder. This surgery is performed through a small incision in the abdomen while the patients receives a general anesthesia. The most common side effect of this surgery is frequent urination due to the new size of the bladder.

3. Radical cystectomy: This is a type of surgery where the entire bladder is removed together with adjacent lymph nodes, part of the urethra, the prostate gland, seminal vesicles (which produce part of the fluid in the semen), and part of the vas deferens (a duct that carries sperm from the testes tubes to the ejaculatory duct) in men, and ovaries, fallopian tubes, and part of the vagina in women. Radical cystectomy is performed in patients with superficial or invasive bladder cancer which has affected a large portion of the bladder. During this surgery, the doctor reconstructs an artificial bladder or attaches an internal or external pouch allowing the urine to collect. The side effects can affect the patient’s life quality.

The most common side effects are:
- For women: infertility, menopause, discomfort during intercourse.
- For men: impotency, inability to get or maintain an erection.

4. Bladder reconstruction surgery: This is a type of surgery where a new bladder is made, after the cancerous bladder is completely removed. There are three techniques used to construct the new drainage:
- Ileal bladder: The new bladder that allows the patient to urinate “normally” is built from a part of the small intestine (ileum). This procedure is more efficient for men because it provides a good daytime urinary control. Women patients have hard time completely emptying the neobladder and some need to use a catheter.
- Ileal conduit: This procedures connects together ureters at one end with a piece of small intestine to the surface of the skin in the navel. The urine is collected into a flat, watertight bad attached to the abdomen. This bag has to be emptied regularly.
- Continent reservoir: This procedure uses the intestinal tissue to create an internal pouch that is connected to the navel. The patient uses a catheter to drain the pouch. This type of procedure is rarely used.

5. Urostomy: This is a type of surgery where a new draining urinary channel is built. During this procedure, part of the bladder is removed and the two ureters are joint together at the surface of the abdomen skin. The small hole where the urine leaves the body is called stoma.

In some cases, the doctor reconstructs what is called a uro-rectal conduit. The urine is directed to drain into the rectum, and the urine and the stool are passed together through the rectum.

These types of surgeries can change the patient’s life quality, especially those that involve major changes of the urinary tract. One of the major problems is the psychological discomfort caused by the new body image that the patient develops after surgery. This is a problem that can be solved in time by accepting the new changes or with psychological help.

Chemotherapy
Chemotherapy is a systemic treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them. This type of treatment involves either a single drug, or a combination of several drugs, and it is usually administered in cycles where a treatment period is followed by a recovery period.

Chemotherapy can be administrated intravenously in advanced stages of bladder cancer where the cancer has spread to other parts of and organs within the body, or inserted directly into the bladder through urethra.

Chemotherapy can be used 1) as a primary treatment in advanced stages of cancer, 2) as an adjuvant treatment (in addition to the surgery to reduce the risk of cancer relapse), or 3) as a neoadjuvant treatment (before surgery to reduce the size of the tumor).

The standard treatment for advanced bladder cancer includes a combination of the following four drugs: methotrexate, vinblastine, adriamycin and cisplatin. Another treatment approach is a combination of two other drugs: gemcitabine and cisplatinum.

Like every medicated treatment, chemotherapy causes side effects. The complexity and extent of the side effects depend on the chemotherapy drug and its dosage. The most common side effects include:

Lower resistance to infections (caused by a reduced number of white blood cells).
Easy bruising and bleeding (caused by a reduced number of platelets which help the blood to clot).
Anemia (caused by a reduced number of red blood cells).
Nausea and vomiting.
Mouth sores.
Temporary hair loss.
Loss of appetite.
Early menopause in women (which causes hot flushes, dry skin, vagina dryness, low libido, anxiety.)
Contraception.

Radiation Therapy or Radiotherapy

Radiation therapy or radiotherapy uses high-energy rays or particles to destroy cancerous cells. This is a frontline treatment for bladder cancer patients. In some cases, radiation therapy is used as an alternative to surgery in the attempt to save the bladder. Radiation therapy is mostly used after surgery to destroy the remaining cancerous cells.

Radiation therapy can be administrated in two ways to the bladder cancer patients:

External radiation therapy: This form of radiation therapy uses a device called a linear accelerator that generates an external beam that is concentrated on the tumor area and breaks it up into smaller pieces. Sessions last between 10 and 15 minutes and are administered every day for 4 to 7 weeks.
Internal radiation therapy or brachytherapy: The radiation is administrated from radioactive materials such as seeds, by a capsule inserted into the tumor or through thin tubes or wires inserted into the tumor.

Radiation therapy side effects include:

Skin irritation (the skin becomes red or fades into a tanned color, becomes dry, or tender in the area where the body is irradiated).
Tiredness.
Vaginal dryness in women.
Impotence in men.
Diarrhea.
Bladder or bowel incontinence.

These side effects are temporary and they disappear when the treatment stops. Some of them can be controlled and diminished with medication.

Biological therapy or Immunotherapy
This is a systemic type of treatment (affects cells throughout the entire body) used to improve the body’s natural defenses. This treatment uses the body’s immune system either to fight against cancer, or to decrease the side effects caused by the cancer treatment, by administrating substances made by the body or created artificially in the laboratory.

One other treatment option for bladder cancer patients is the intravesical immunotherapy. This treatment uses a solution that contains Bacillus Calmette-Guerin (BCG), a bacterial organism that is sometimes used to treat tuberculosis, to fill the bladder. This substance stimulates the bladder to respond against cancerous cell that remained after the tumor removal by killing them. Intravesical immunotherapy is administrated through a catheter (a flexible tube) two hours per week for at list 6 weeks. The success rate for this treatment is approximately 70 to 80 percent.

The side effects of the intravesical immunotherapy include:

Bladder irritation.
Blood in the urine.
Flu-like symptoms.

Photodynamic therapy
This is a cancer treatment that involves two steps. First, the patient receives a special drug that is absorbed mostly by the cancerous cells. Then, the cells are exposed to a light from a laser which makes the drug active. This way, only the cancerous cells are destroyed or severely damaged. The advantage of this new treatment is that it causes little damage to the healty tissue.
Photodynamic therapy’s side effects include:

Chronic bladder infection.
The bladder can shrink.
Long-term sensitivity to sunlight.

Article by Alina Morrow, MS
Medical Writer
OmniMedicalSearch.com

Sources:

Cancer Research UK, Bladder cancer, January 2007
The University of Texas, M.D. Anderson Cancer Center, Bladder Cancer, December 2005
Genetics Home Reference, Bladder cancer, January 2007
MayoClinic.com, Bladder cancer, April 2006
Cancerbackup.org, Bladder cancer information center, February 2007
National Cancer Institute, Bladder Cancer (PDQ®): Treatment, December 2006
OnkoLink, Abramson Cancer Center of the University of Pennsylvania, Ryan P. Smith, MD, Bladder Cancer: The Basics, August 2003
Medline Plus, Bladder cancer, April 2007