Treatments and procedures for bladder cancer
Doctors use different methods to treat people who have bladder cancer. Before doctors start with treatment, they encourage patients to consider the option of clinical trials. Doctors prefer to determine whether the clinical trial option is safe, effective, and better than any standard treatment. With the help of a clinical trial, doctors can test a new drug, they can also test different combinations of standard treatments. From clinical trials, doctors can also examine the effectiveness of any new doses and treatments.
Doctors often work together to make the entire treatment plan for the patient who has cancer. The treatment plan has several combinations of different types of treatment. The team of doctors that comes together to work out a treatment plan for the cancer patient is called a multidisciplinary team. It is called so because all doctors belong to different disciplines. The urologist usually leads the team. Urologists are specialists in the genitourinary tract that includes the kidneys, genitals, bladder, prostate, and testicles.
Before the doctors begin the treatment, they consider certain factors such as
- type and stage of bladder cancer,
- possible side effects,
- patients preferences, and
- overall health.
The treatment plan is always followed by a care plan that covers the medical procedures for any symptoms and side effects. The care plan for bladder cancer treatment is one of the more important parts of the overall treatment.
Surgery is done to remove the tumor that surrounds the healthy tissue while doctors are operating. Different surgeries are available for treating bladder cancer. There are essentially three types of surgeries: transurethral bladder tumor resection (TUBRT), cystectomy, and urinary diversion.
TURBT is the procedure that is used to diagnose and stage the bladder cancer. While TURBT is ongoing, the doctors use the cystoscope and insert it through the urethra into the bladder. The tumor is then removed with the help of a small wire loop, a laser, or high-frequency electricity, i.e., fulguration. To save the patient from feeling the pain, an anesthetic is administered before the procedure begins.
In cystectomy or radical cystectomy, the bladder is removed and sometimes removed along with the nearby tissues and organs. In men, if the bladder cancer is too intense, the prostate and urethra can be removed too. In women, the uterus ovaries, fallopian tubes, and part of the vagina can be removed during the surgery, if needed. Apart from the tissues and organs, the lymph nodes present in the pelvis are removed in both men and women. This process is called pelvic lymph node dissection.
Urinary diversion is another surgery procedure that includes removal of the bladder. The doctor creates another way for the urine to pass since it can no longer pass through the bladder. In urinary diversion, a section of the small intestine or the colon is used to divert the urine to a stoma (an opening), outside of the body. Post surgery, the patient wears a bag that is attached to the stoma, so it collects and drains the urine.
Chemotherapy is another treatment to cure bladder cancer. Chemotherapy is the treatment where there is a use of drugs to destroy cancer cells, which is done by restraining the cancer cells to grow and divide further. There are two types of chemotherapy: intravesical and systemic.
Intravesical chemotherapy is given by the urologist in most cases. While intravesical chemotherapy is ongoing, the drugs get delivered into the bladder using a catheter that is inserted through the urethra. The drugs that are used in intravesical chemotherapy are Mitomycin, thiotepa, cisplatin, doxorubicin, gemcitabine, and valrubicin.
Systemic chemotherapy is prescribed by a medical oncologist usually. Systemic chemotherapy treats cancer by going into the bloodstream and reaching cancer cells in the entire body.
Immunotherapy is also referred to as biologic therapy to boost the body’s natural defenses to fight cancer. The motive here is to improve, target, or reinstate the immune system function. The standard drug that is used in immunotherapy is called Bacillus Calmette— Guerin (BCG), which is weakened enough to not cause harm yet treat the cancer. This drug is weakened because it’s akin to the bacteria that causes tuberculosis. This drug is directly inserted into the bladder using the catheter.
Another type of immunotherapy is called Interferon that can be given as an intravesical therapy. This therapy is combined with BCG in some cases if required.
Radiation therapy, being one of the treatments of bladder cancer, uses high-energy x-rays to destroy all cancer cells. The doctor who specializes in giving this radiation therapy is called a radiation oncologist. Radiation therapy is often not the primary treatment for bladder cancer. It is usually given after one treatment has been completed, or while one’s treatment is ongoing.