Treatment options for bladder cancer are determined based on the cancer's stage: Stage 0 (applicable in papillary carcinoma and carcinoma in situ), Stage I, Stage II, Stage III or Stage IV. There are four standard treatments Ð surgery, radiation therapy, chemotherapy and biologic therapy, which are used alone and in combinations to treat bladder cancer.
A transurethral resection (TUR) is a procedure in which a cytoscope (a thin, lighted tube) is inserted into the bladder through the urethra, and then with a small tool either removes the cancer or burns it away with heat from an electric current ( fulguration ).
A radical cystectomy is the surgical removal of the bladder and any lymph nodes and nearby organs that contain cancer in men, this could include the prostate and the seminal vesicles while in women, this could include the uterus, ovaries and/or part of the vagina. Since the bladder is removed, the surgeon will also perform a urinary diversion to create a new way for the body to store and pass urine, through reconstruction such as an ileal conduit .
A partial cystectomy or segmental cystectomy, removes just a section of the bladder and is used for low-grade tumors that are limited to one area of the bladder. Patients who receive this type of surgery do not need reconstruction for the urine system.
Patients who undergo surgery may also receive other types of treatment after surgery, called adjuvant therapy , to lower the risk of cancer recurrence.
Radiation therapy uses high energy radiation to kill cancer cells. The type and stage of cancer will determine if internal or external radiation therapy could be beneficial.
Internal radiation therapy or brachytherapy places an implant (needles, seed, wire or catheters with a radioactive substance sealed inside) directly into or near the cancer.
External radiation therapy or external beam radiation sends radiation into the body from outside. This type of radiation therapy is more commonly used for bladder cancer and is often combined with chemotherapy to destroy cancers that would otherwise need to be treated with a cystectomy.
Chemotherapy uses specific drugs or a combination of drugs (combination chemotherapy) approved for bladder cancer to stop or slow the growth of cancer. With systemic chemotherapy, drugs are administered by mouth or injected into a vein or muscle.
Regional chemotherapy involves placing the chemotherapy drug directly into the cerebrospinal fluid (in an organ or a body cavity) and in the case of bladder cancer, putting the chemotherapy drug directly into the bladder via a catheter.
Immunotherapy (also called biologic therapy ) uses the patient's immune system to fight cancer by boosting the system's natural defenses to recognize and target cancer cells. An intravesical biologic therapy, inserted via catheter into the bladder, stimulates the patient's immune system to destroy cancer cells in the bladder.