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Bladder Cancer Treatment Options

Bladder Cancer is Cause of Concern World-wide

In today’s time, with advanced technology and skilled professionals hands, any kind of known cancer is completely treatable; though better results are expected only when apt diagnose of the illness and timely medical procedures are started. Determining treatment option and designing a well effective schedule to achieve healing relies on many different aspects such as patient’s age, overall health, size of the tumour and most importantly stage of the cancer. In such cases, healthcare provider is not only the one doctor but an appropriate team of experts decide and provide services which consist of an Oncologist, Radiation Oncologist, Urologist and Geriatrician.

In this post, we will quickly glance through the broad categories and names of the treatment options suitable for the bladder cancer.

There are three main types of bladder cancer:

(i) Urothelial Carcinoma (UCC) or Transitional Cell Carcinoma (TCC): This type is the most common (90%).

(ii) Squamous Cell Carcinoma (SCC)

(iii) Adenocarcinoma

We can categorise bladder cancer broadly as per the stage and grade.

  • Early bladder cancer
  • Invasive bladder cancer
  • Locally advanced bladder cancer

1. Common Surgeries for Bladder Cancer Treatment

Cancer surgery is done to remove the cancerous tumour from the organ. There are several surgical options available depending upon each patient’s individual medical condition to treat the bladder cancer. Most common alternatives are given as below:

a) Transurethral Resection of Bladder Tumour (TURBT) Or Transurethral Resection (TUR)

This surgery is often used when tumour is in early stage and a diagnosis is required to confirm cancer. Once presence of cancerous cells is determined, the next step is to find out whether cancer has spread to bladder wall. This medical procedure is a small surgery which should be done in the hospital by experts. However it does not require lengthy hospital stay and normally the patient get discharged within 24 hours.

b) Cystectomy

This procedure (surgery) is used when a patient’s bladder cancer is spreading around fast therefore all or part (portion) of the bladder may need to be removed. One or more small incisions (cuts) are made in the abdomen to remove the tumour. General anaesthesia is given during this surgery. A patient needs to be hospitalised for a week in a normal condition and thereafter can go home and start routine work after few weeks.

Cystectomy has two types:

  • Partial cystectomy: Part of the bladder is taken out and rest of the bladder can function as before.  
     
  • Radical cystectomy: Entire bladder and nearby lymph nodes are removed.

c) Reconstructive Surgery after Radical Cystectomy

When whole bladder is taken off, life is not the same hence various other kinds of reconstructive surgeries can be done to establish a proper substitute to store urine.

  • Incontinent Diversion: A small piece of the patient’s intestine is taken and connected to the ureters. This makes an arrangement wherein urine is excreted straight from the kidneys through the ureters outside the body. A small bag is fixed over the stoma to collect the urine (needs to be emptied once it is full) and the patient has no control on urination.
  • Continent Diversion: In this procedure, a bag is created from the intestine, attached to the ureters and one side of this bag is connected to stoma with an opening in front of the abdomen.  A valve and a drainage tube (catheter) is also fixed to manage emptying this pouch. Patient prefers this option as bag is not placed outside.
  • Neobladder: It is developed by a piece of intestine and a route is made to send back urine to urethra for storing it. Neobladder is attached (sewn) to the urethra and make urination function normal.

2. Intravesical Therapy

This is the therapy in which the doctor puts a liquid drug directly into the bladder (through a catheter). In this way the drug can affect the cells lining the bladder without having major effects in other parts of the body. 

This therapy has two types of treatment:

  • Immunotherapy: An injection with a germ called Bacillus Calmette-Guerin (BCG) given straight into the patient’s bladder through a catheter which helps body’s immune cells to reach bladder and fight the cancer cells present there.
     
  • Intravesical Chemotherapy: It is a method where cancer-fighting medications are injected into the bladder through a catheter. Chemotherapy works to kill the harmful cells.
     
  • Systemic Chemotherapy: Chemo (drugs) are given through an IV. Medication moves in the whole body through the bloodstream to kill cancer cells.

3. Other Types of Chemotherapy

  • Electrically Stimulated Chemotherapy: In this therapy, small electrical current is passed through the bladder while chemo drugs are in the bladder.
     
  • Hyperthermia with Mitomycin C : Chemotherapy drug mitomycin C is given into your bladder and same time a small microwave probe heats up your bladder wall.

4. Radiation Therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Normally, this is not the primary treatment for bladder cancer, but it may be given in combination with chemotherapy. Most often, radiation treatment process is painless and given 5 days a week for several weeks. Following are the main two types:

  • External Beam Radiation Therapy:  Radiation used from an outside source (machine) to kill bladder cancer.
  • Internal Radiation Therapy Or Brachytherapy: In this process radiation is given using implants.

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