Treatment of bladder cancer is based on when it's first diagnosed. Bladder cancer has five stages and based on the stage the cancer is detected, the treatment varies. The sooner the cancer is detected, the better the chances of survival. Other factors, such as the tumour size, the rate at which the cancer cells are multiplying, and a person’s overall health also affect treatment options.
Surgery is a part of the treatment plan for most bladder cancers. The stage and extent of the cancer determines the type of surgery done.
A Transurethral Resection of Bladder Tumour (TURBT) is the most common surgical treatment for early-stage or superficial bladder cancers. Though the surgery is a minimally invasive one, it is usually done under general or local anaesthesia. This is to reduce the unpleasant effects that one may feel. In this procedure, a thin wired instrument called a resectoscope or cystoscope is inserted into the bladder through the urethra. It contains a camera for viewing and a wire loop for cutting the tumour. The surgeon can identify the tumour tissues through the camera and removes it by using the loop. Fulguration, a procedure where the base of the tumour is burnt is also done to remove any remnants of the tumour.
Cystectomy is a procedure where the bladder is removed partially or completely. The procedure is done by open, laparoscopic or robotic methods depending on the discretion of the surgeon. Laparoscopic and robotic techniques have the advantage of lesser complications and faster recovery. The average hospital stay is about 5 to 7 days. A person can return to normal activities within in a month of the procedure. Partial cystectomy is rarely done because of the extent of cancer into the muscle layers. Adjacent lymph nodes are also removed. The main advantage of this surgery is that the bladder is not removed completely which helps to avoid reconstruction surgery
Radical cystectomy operation removes the entire bladder and nearby lymph nodes. Also, the prostate and seminal vesicles are also removed in men. In women, the ovaries, fallopian tubes, the uterus (womb), cervix, and a small portion of the vagina are often removed along with the bladder. A bladder reconstruction surgery is usually done after radical cystectomy.
Reconstructive surgery after radical cystectomy:
In reconstructive surgery, an artificial bladder is made using a part of the small intestine. There are three main types of reconstruction surgery.
Incontinent diversion: In this, a passage called an ileal conduit is made for the urine to pass from the kidneys to the outside of the body. The urine passes from the kidneys to the ileal conduit through the ureters. It is then passed outside through an opening called stoma that is made in the skin of the abdomen. This is called urostomy. A small bag is placed over the stoma to collect the urine that comes out continuously in small amounts. The bag is emptied from time to time or when it is full. This approach is called an incontinent diversion because the patient is no longer in control of the flow of urine.
Continent diversion: Another way for urine to drain is called a continent diversion. In this approach, a pouch is made from the piece of intestine and is attached to the ureters. This pouch serves as a bladder where the urine is collected. The pouch also has a valve that opens only inwards. The other end of the pouch is connected to an opening (stoma) in the skin on the front of the abdomen. The pouch is emptied several times a day by putting a catheter into the stoma through the valve. The advantage is that there is no bag on the outside to collect urine.
Neobladder: In this method, a part of intestine is redesigned as a proper urinary bladder. One end of it is connected to the ureters and the other end to the urethra. This helps in normal urination.
The usual risks are bleeding, infection, and damages to the nearby organs.
Specific risks of cystectomy are:
• Urine leaks
• Pouch stones
• Blockage of urine flow
• Sexual dysfunction
Chemotherapy uses drugs to destroy cancer cells. The drugs are given orally or intravenously. Chemotherapy is done before surgery to shrink the tumour or after surgery to prevent the return of cancer. It is also given in combination with radiotherapy. Chemotherapy is also given as a palliative measure to relieve symptoms when a cure is not possible. Chemotherapy is usually done in cycles with appropriate intervals in between.
Intravesical therapy is usually an option for people with non-invasive (stage 0) or minimally invasive (stage I) bladder cancer. In intravesical therapy for bladder cancer, drugs are put directly into the bladder through a catheter. Both immunotherapy and chemotherapy drugs can be given this way. This approach is useful only in early stage cancers where the cancer is limited to the lining. Intravesical therapy does not reach the deeper layers of the bladder wall, the kidneys, ureters or urethra.
There are two types of intravesical immunotherapy:
Bacillus Calmette Guerin (BCG) therapy: BCG is a type of intravesical immunotherapy, used to treat early-stage bladder cancer. In this treatment, BCG is inserted into the bladder through a catheter activating the natural immune system. BCG is usually given for one to six weeks and may be given alongside transurethral resection. Less commonly, BCG is given as a long-term maintenance treatment.
Interferon therapy: Intravesical Chemotherapy- Drugs are directly introduced to the bladder with the help of a catheter.