Bladder Cancer: Treatments

The treatments for bladder cancer can include:

Surgery

Three-quarters of bladder cancer patients have superficial or early cancer when they are first diagnosed. Local surgery in the bladder with a cystoscope is usually their first treatment.

Transurethral Surgery (TUR)

TUR is performed using a cystoscope, the same instrument used for diagnosis, consisting of a tube with a camera chip and a light inserted through the urethra into the bladder. This scope has a wire loop at the end to remove suspicious tissue and tumors. Surgeons may also use lasers and other devices to destroy the base of the tumor (a procedure called fulguration). Since bladder cancer tends to recur, surgeons at Columbia University Department of Urology follow bladder cancer patients closely and are pioneering numerous new treatments to prevent recurrence and progression.

Cystectomy

This operation is used to treat more invasive bladder cancers. A partial cystectomy is performed when cancer has invaded just one part of the bladder wall for individuals who are unlikely to tolerate a complete cystectomy .  A radical cystectomy is performed when the cancer has spread farther throughout the bladder. In a radical cystectomy surgeons remove the bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells. In men they may also remove the prostate, seminal vesicles, and part of the vas deferens. Women undergoing radical cystectomy may have the cervix, uterus, ovaries, fallopian tubes, and a very small part of the vagina removed.

Whenever possible, Columbia Urology experts perform cystectomies using minimally invasive robotic laparoscopy.  Surgeons control robotic arms that hold miniaturized instruments. This approach only requires a few small incisions in the abdomen, leading to a faster recovery time.

Reconstructive Bladder Surgery (Neobladder)

If the entire bladder must be removed, reconstructive surgery can create an alternative way to store and eliminate urine. Columbia Urology has been at the forefront in reconstructive techniques for patients after radical cystectomy. Our surgeons create a new bladder (neobladder) in appropriate patients, using a portion of the small intestine. This is attached to the urethra, allowing both men and women to urinate in a more normal manner after bladder removal. Complication rates for neobladder creation at Columbia Urology are among the lowest reported in the nation.

If our surgeons cannot create a neobladder they create an internal bladder connected to an opening in the abdomen. Patients can drain this reservoir several times a day using a catheter. Another alternative is an ileal conduit allowing the urine to pass through a passage in the small intestine.  This drains continuously through an external bag. This procedure has a low rate of complication and a high rate of patient satisfaction.

More information can be found here.

Chemotherapy

Chemotherapy is an important factor in therapy for some bladder cancers.

Chemotherapy drugs that destroy cancer cells may be delivered directly into the bladder through a tube or catheter. This is called intravesical therapy. Medicines given this way mainly affect the cells lining the bladder, with little to no effect beyond this area. For this reason, it is used only for non-invasive or minimally invasive cancers and usually after BCG therapy has been used.

Columbia Urology researchers have done pioneering and innovative research proving the efficacy of docetaxel (Taxotere), an injectible drug, for patients who do not respond to therapy delivered directly to the bladder. While these individuals are often counseled to have their bladders removed, this treatment may allow many to keep their bladders.

Columbia Urology researchers are also conducting a clinical trial of the effectiveness of the chemotherapeutic agent paclitaxel (Abraxane) when applied directly to the bladder.

Systemic chemotherapy administered intravenously is used in nearly all cases where the bladder is to be removed. Chemotherapy may be given prior to surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy) however the best evidence to date supports the administration of chemotherapy to patients prior to removal of the bladder.

Chemotherapy is also used for metastatic bladder cancer if the disease has spread to other organs.

Radiation Therapy

Radiation therapy is generally used as part of a treatment plan involving systemic (intravenous) chemotherapy and aggressive surgery (TUR) to remove as much tumor as possible.

Radiation therapy may be to shrink the tumor before surgery to make the procedure easier.  It may also be prescribed for select patients to preserve the bladder. During radiation therapy doctors use high-energy rays aimed at the cancer from outside the body.

External Beam Radiation Therapy is the most commonly used form of radiation to treat bladder cancer.  The patient sits or lies on a couch and an external source of radiation is aimed at the patient’s tumor. Radiation therapy treatments are delivered in a series of daily sessions. Each treatment is painless and will last less than 30 minutes, five days a week, Monday through Friday, for several weeks.

More information can be found here.

Immunotherapy

Immunotherapy stimulates the patient’s own immune system to defend itself against the cancer. This is generally delivered directly to the bladder (intravesically).

For early stage, superficial bladder cancer an effective treatment is the immunotherapeutic agent Bacille Calmette-Guerin (BCG). This is instilled into the bladder weekly for six weeks. Once in the bladder, BCG appears to stimulate an immune reaction against the tumor cells. BCG prevents recurrence in up to two-thirds of cases of superficial bladder cancer.