Treatment of bladder cancer
Treatment depends on the stage of bladder cancer.
There are three stages with different treatment options and outcomes,
These are:
Superficial
Superficial bladder cancer is early cancer that is only growing in the lining of the bladder. The treatment is transurethral resection of bladder tumour (TURBT) this is a quick operation where the tumours which look like little warts are scraped off the inside of the bladder using a cystoscope. These tumours have a high chance of growing back and so regular cystoscopies are needed sometimes up to every three months to check for this and keep the bladder cancer under control. The recovery time from this type of surgery is about 24-48 hours and there are no longer term disabling effects.
The majority of these patients will get re-growth of their bladder cancer in time but most will have recurrent superficial bladder cancer. They simply require further localised treatment. However over the years about 10 to 30% of people with superficial bladder cancer will go on to develop invasive bladder cancer
Of those people with superficial bladder cancer some will be identified as having a high risk of developing invasive cancer or cancer throughout the bladder. People with high risk superficial bladder cancer will be offered extra treatment after the TURBT to prevent this from happening. The usual sort of treatment is intravesical therapy, this means using a catheter to put a drug solution into the bladder for an hour or so. This type of treatment is usually given once a week as an outpatient for 6 weeks. Maintenance therapy may be given every 3 months for several years as long as the treatment continues to work. The types of drugs used include
- Chemotherapy drugs
- BCG vaccine
The side effects from these treatments include Flu like symptoms and irritation of the bladder, symptoms of irritation are
- Frequency
- Urgency
- Haematuria
The effects of the condition and its treatment are not disabling.
Very rarely intravesical BCG therapy may lead to an infection similar to TB; this requires treatment with anti-TB drugs but is unlikely to have any long term disabling effects.
Invasive
Invasive bladder cancer is cancer which has spread into the muscle lining the bladder but not to other organs. If left untreated there is a high chance the bladder tumour will spread to local lymph nodes or other organs outside the bladder - becoming advanced bladder cancer and eventually fatal. The primary treatment of this type of disease is either major surgery or radical radiotherapy
- Major Surgery - to remove the whole bladder and local lymph nodes, this will mean a person needs to have a urostomy (a stoma for urine) or a bladder reconstruction. Removal of the bladder is called a cystectomy. In men the prostate is removed aswell (sometimes called cystoprostatectomy) and in women the uterus and ovaries are often removed as well (hysterectomy and oophorectomy). A section of small bowel is used to make a receptacle to collect urine from the kidneys. This small bowel is called an ‘ileal conduit’ when it is used to make a urostomy stoma and a ‘neo-bladder’ when it is attached to the urethra making a bladder reconstruction.
- Radical Radiotherapy - to the bladder and pelvis.
Chemotherapy - may often be used with either radiotherapy or surgery and this is to clear up any remaining cancer cells not destroyed by the local treatment in the pelvis.
Advanced or metastatic
Advanced bladder cancer is when the cancer has spread outside of the bladder into other organs; this may be locally to the uterus, ovaries, rectum or prostate gland or more generally to the lungs or liver (metastases). A particular problem for people with locally advanced bladder cancer is lymphoedema of the legs. Average survival with supportive treatment only is 2-4 months. With maximal treatment including cisplatin based chemotherapy this can be extended to 12-14 months with 20% of people treated like this living for 3 years or more. However many people will not be fit enough to undergo this treatment and up to date information from the treating hospital will be vital in deciding on award.
Amended June 2008
