Treatment for Superficial Bladder Cancer
Superficial bladder cancers account for the majority of diagnoses. These tumours are confined to the bladder mucosa and are treated in the first instance by endoscopic resection. Samples of the bladder muscle will also be undertaken to ensure that muscle invasion has not occurred.
Additional treatment by intravesical chemotherapy may also be recommended if you have:
- Multiple tumours
- A high grade tumour(/s)
- A rapidly recurring tumour(/s)
Intravesical chemotherapy or immunotherapy involves introduction of a drug directly into the bladder in an attempt to prevent recurrence. The most commonly used agent is calledBCG, this drug is administered once a week for six weeks. Following initial treatment, a three year maintenance program of BCG in three weekly installations every six months is now generally recommended for most superficial bladder cancers.
As superficial bladder cancers tend to recur over time, regular check ups are necessary lifelong. This is called a bladder cancer surveillance program. It will involve periodic repeating of urinary cytology and cystourethroscopy. The interval between check ups depends on several factors: how many tumours are present in your bladder, the grade of the tumours and how frequently the tumours recur.
It is important to comply with your surveillance program as approximately 15% of superficial bladder tumours progress to invasive cancers.
Treatment for carcinoma in situ
This is a pre-invasive from of bladder cancer which is confined to the bladder mucosa at diagnosis. These tumours are aggressively pre-malignant.
Symptoms include irritative lower urinary tract symptoms, such as dysuria in the absence of infection. Because the symptoms mimic urinary tract infection, patients may be inappropriately treated with empirical antibiotics.
Voided urinary cytology is generally positive and cystourethroscopy is mandatory where carcinoma in situ is suspected. Areas of carcinoma in situ are visible to naked eye and appear as reddened, raised patches in the bladder wall. Where possible, these are treated with local ablation and generally also require BCG therapy.
Again, regular check ups are necessary lifelong.
Treatment for muscle invasive bladder cancer
Muscle invasive bladder cancer may occur spontaneously or from areas of superficial bladder cancer or carcinoma in-situ. Muscle invasive disease is an aggressive form of bladder cancer requiring early intervention and careful follow up. Complete removal of the bladder, called radical cystectomy, has the potential of cure and is usually recommended. Treatment with radical pelvic radiotherapy may also be an option.
In suitable patients functional re-construction known as neo-bladder formation is possible and desirable. This surgically constructed neo-bladder is created out of a section of bowel which is completely resected and refashioned into a pouch that replaces your cancerous bladder. The ureters and the urethra are surgically attached to this neo-bladder. The bowel ends are rejoined so your bowel functions as normal.