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Bladder Cancer Treatment

All treatment for bladder cancer is based on the stage and grade. We typically divide bladder cancers into two groups: non-invasive or invasive, and create a treatment plan based on the grade of the tumor, with low-grade tumors being less aggressive.

Low Grade, Non-invasive
These tumors tend to be less aggressive with respect to the ability to spread and cause death. However, these tumors have a propensity to recur. Treatment for these tumors typically involves surveillance cystoscopy every 3-6 months with repeat transurethral resections of bladder tumors (TURBT's), if appropriate. Chemotherapy, more invasive surgery and radiation therapy are reserved for extenuating cases only.

High Grade, Non-invasive
If you have been diagnosed with a high grade, non-invasive bladder cancer, the standard of care is for your urologist to perform another TURBT. This is recommended because about 50% of tumors thought to be non-invasive on initial TURBT will be found to be invasive on subsequent TURBT.
After your re-resection, if you still have high grade, non-invasive disease, there are a few options for treatment available to you.

Surveillance cystoscopy with repeat TURBTs as necessary is one option, however, high grade tumors have a much higher likelihood for recurrence and progression to invasive disease. As a result, this is not the standard first option, but can be considered in patients who decide this is best for them.

Intravesical (inside the bladder) therapy is the standard for patients with high grade, non-invasive bladder cancer. This is accomplished by placing a medication into the bladder once weekly for six straight weeks to help combat recurrence and progression of your bladder cancer.

The typical agents used for this are BCG (Bacillus Calmette–Guérin) and mitomycin C. BCG is an attenuated form of the tuberculosis bacteria and has been shown to improve recurrence rates and progression of bladder cancer. Mitomycin C is a chemotherapeutic agent that works to accomplish the same. Both have been shown to improve recurrence rates, but most urologists prefer BCG because of some data indicating it may help in reducing progression to invasive disease. If you have high grade, non-invasive bladder cancer, talk to your urologist about intravesical therapy and see if it is the right choice for you.

Invasive, High or Low Grade
Invasive bladder cancer is when the cancer invades the muscular, outer layer of the bladder (muscularis propria/detrusor muscle). When this occurs, the risks of recurrence and spread of the cancer increase dramatically, and, as a result, more aggressive therapy is recommended. If you have been diagnosed with invasive bladder cancer, the two mainstays of treatment are surgical removal of the bladder and radiation therapy. Chemotherapy is now recommended as an adjunct to both surgery and radiation.

Surgery
As mentioned earlier, all patients with muscle invasive bladder cancer should be offered chemotherapy prior to undergoing surgery. Large, high quality medical studies have shown that chemotherapy in this setting has improved the survival of patients who get it versus those who do not. If you are seeking treatment for bladder cancer, the Eleanor N. Dana Cancer Center at UT Health offers multidisciplinary cancer care where you can meet your medical and urologic oncologist on the same visit to discuss the various chemotherapy options for invasive bladder cancer.

With respect to surgery, invasive bladder cancer was traditionally treated with a large, open incision to remove the bladder and prostate (cystectomy). Advances in laparoscopic and robotic technology have shifted the paradigm for the surgical management of bladder cancer from open to laparoscopic/robotic surgery. If you have invasive bladder cancer and have elected for surgery, make sure you inquire about your doctor's ability to do this laparoscopically/robotically.

You should also inquire about your surgeon's outcomes. Specifically, you should ask to know your surgeon's outcomes with respect to surgical margins, recurrence rates and conversion to open surgery. If your doctor is unable to offer minimally invasive cystectomy or is unable to tell you his/her outcome results, make sure to get a second opinion with a physician who is specialty trained in this area. Our fellowship-trained robotic urologic oncologists at UT Health have expertise in the most up-to-date and cutting-edge surgical therapy for bladder cancer and are the highest volume surgeons for this technique in the region.

Removing the bladder is the first step in surgical therapy for bladder cancer. Reconstructing the urinary tract is the second, and equally important part of the procedure. Our specialists provide all reconstructive techniques from neo-bladders to ileal conduits as methods of urinary tract reconstruction. It is very important that you discuss the different types of reconstruction and their required maintenance prior to making a decision on which type would be best for you.

Radiation
Radiation therapy can be used, in conjunction with chemotherapy, to offer patients the opportunity for bladder preservation for invasive bladder cancer. Radiation therapy offers the advantages of being a minimally invasive treatment, allows you to keep your bladder, eliminates the need for urinary tract reconstruction and does not require the same type of recovery as surgery.

However, radiation therapy can have long-lasting side effects of radiation-induced bleeding from the bladder and long-term urinary frequency, urgency and leakage of urine. Also, recurrence rates following radiation therapy are higher than those compared to surgery, and up to 50% of patients will experience a treatment failure after radiation therapy for invasive bladder cancer. Failure after radiation is complex and may require surgery. Make sure to discuss these issues with your radiation oncologist if you are considering radiation therapy for your bladder cancer.

To schedule an appointment with a UT Health bladder cancer specialist, call 419.383.6644.

Last Updated: 6/1/16