From surgery to immunotherapy

A clutch of factors guide treatment options for bladder cancer. These would include the type, grade and stage of the cancer, which are all taken into consideration, along with the patient’s overall health and treatment preferences. Accordingly, the plan could include more than one type of treatment

Bladder cancer treatment options include:

Surgery

Surgery is the principal treatment tool for bladder cancer. The type of surgery would depend on the location of the cancer. In addition to surgery, other treatments might also be given.

Types of surgery include:

Transurethral resection (TUR) with fulguration: In this procedure, the doctor inserts a thin lighted tube (cystoscope) into the bladder via the urethra. Then, an instrument with a small wire loop is used to remove the cancer or through high-energy electricity, burn the tumour away (fulguration).

Partial cystectomy: This is a procedure that removes part of the bladder, often done on patients with a low-grade tumour that has invaded the bladder wall, but is confined to one area of the bladder. Patients can urinate normally once they recover from surgery.

Radical cystectomy with urinary diversion: This surgery removes the entire bladder and any lymph nodes or proximal organs containing cancer, the prostate and seminal vesicles in men, and the uterus, ovaries and part of the vagina in women. This is done when the cancer invades the muscle layers or when non-muscle-invasive bladder cancer involves a large part of the bladder. When the whole bladder has to be removed, urine is diverted to create an alternative way for the body to store and pass urine.

Radiation therapy

This mode uses high-energy X-rays or other types of radiation to kill cancer cells or arrest their growth. Bladder cancer is sometimes treated by external beam radiation therapy which uses a machine outside the body to send radiation toward the cancer. Radiation therapy is either given in isolation or with other forms of treatment like chemotherapy.

Chemotherapy

This treatment uses certain drugs to stem the growth of cancer cells, by killing the cells or preventing them from multiplying. Chemotherapy is either given in isolation or along with other forms of treatment, depending on the type and stage of cancer being treated.

Types of chemotherapy:

Systemic chemotherapy: In this mode of chemo for bladder cancer, the drugs are injected into a vein. This way, the drugs enter the bloodstream to reach cancer cells throughout the body.

Intravesical chemotherapy: In this method, chemotherapy is administered into the bladder through a tube inserted into the urethra. Intravesical treatment can flush the bladder with drugs that destroy residual cancer cells left after surgery, thus lowering the chances of recurrence.

Immunotherapy

This line of treatment helps the patient’s immune system combat cancer. The doctor might advise biomarker tests to help predict the body’s response to specific immunotherapy drugs. Like chemotherapy, immunotherapy is also administered either through systemic or intravesical route.

Targeted therapy

This mode of therapy uses drugs or other substances to impede the action of specific enzymes, proteins or other molecules responsible for the growth and proliferation of cancer cells. Like in immunotherapy, the doctor might advise biomarker tests to help predict the patient’s response to certain targeted therapy drugs.