Bladder Cancer Treatment
Treatment options for bladder cancer include surgery, intravesical therapy, chemotherapy, bladder sparing therapy, biological therapy and radiation therapy. You can rest assured knowing that we have experts in laparoscopic and robotic-assisted bladder cancer surgery should those procedures be required.
You may receive more than one type of treatment, depending on several factors, including the grade of the tumor, where it is located and whether it has spread to other parts of your body. Before we set up a specific treatment plan for your bladder cancer, we will take the following into account:
- Your age, overall health and medical history
- The extent of the disease
- Your tolerance of specific medicines, procedures or therapies
- Expectations for the course of the disease
- Your opinion or preference
We will sit with you and discuss the options available so that you can be as informed as possible when making the decision.
Bladder Sparing and Biological Therapy
Our commitment to treating bladder cancer has led Providence Saint John’s Health Center and the John Wayne Cancer Institute to focus their efforts on the newest trials and protocols for bladder sparing and preventing cancer return. This ranges from medication taken orally, to chemotherapy, and to bladder therapy, which is placed into the bladder.
At Providence Saint John’s Health Center, we treat both early and later stage bladder cancer. With bladder cancer, we aim to preserve the bladder and spare the bladder from removal if possible. Usually the physician performs a bladder biopsy or surgery to remove the tumor from bladder through the urethra. After recovery from this minor procedure, the patient returns to the clinic for review of pathology. If appropriate, weekly outpatient treatment begins. A tube is inserted into the bladder through the urethra to administer the drugs to treat the cancer. This may be done once per week for 6 to 12 weeks, to keep the cancer from returning.
Patients with early bladder cancer may be able to receive a biological therapy called Bacillus Calmette-Guerin (BCG). It uses a weakened bacterium strain to stimulate the body’s natural defenses to attack the cancer. The BCG solution is inserted into the bladder through a catheter into the urethra. Once the solution comes in contact with the bladder tissue, this activates the body’s own immune system to eradicate the cancer.
Unique to Providence Saint John’s Health Center, is a series of treatments that can be used like the BCG and instilled into the bladder. Often patients will be unable to use BCG treatment or the cancer has returned despite the BCG treatment. In those rare cases, different drugs can be heated and instilled into the bladder to help treat the cancer. This method of bladder cancer treatment can often prevent the cancer from returning, prolong the time to recurrence and help the patient avoid complete bladder removal.
In addition, if patient have recurrence of cancer after BCG treatment (called “BCG failure”), we have an exciting new clinical trial using intravenous Pembro. This is an exciting new therapy that turns on the body’s natural immune system. With this agent specifically, dramatic results have been seen in melanoma, and we are optimistic about its activity against bladder cancer.
Surgery is an option for most people with bladder cancer. You and your surgeon can talk about which type of bladder cancer surgery is right for you:
- Transurethral resection, or TUR: The doctor uses a cystoscope to treat early bladder cancer. No cut into your body is needed. No incision is needed. This is a type of bladder sparing procedure.
- Cystectomy: The surgeon may remove all or part of your bladder. Removing only part of the bladder is called a segmental cystectomy. The most common type of surgery involves removing the entire bladder, along with nearby lymph nodes and part of the urethra. This is called a radical cystectomy.
- Robotic bladder cancer surgery: This procedure is known as robotic cystoprostatectomy. Providence Saint John’s specializes in robotic bladder surgery using the da Vinci Surgical System. In this procedure, your surgeon uses a console to control miniature surgical equipment inserted into the body through tiny incisions. This minimally invasive surgery means less blood loss and pain, and a faster recovery.
Urinary Reconstruction and Diversion
When bladder cancer forces the removal of the entire bladder, the surgeon creates another way for urine to be collected, stored and released from the body. There are three ways this can be done. At Saint John’s, our physicians will help you decide which is best for you:
- Artificial bladder: A surgeon uses tissues from the intestines to create what is known as a neobladder. The neobladder is attached to the urethra and allows the patient to urinate normally. We are leaders in the field of this minimally invasive laparoscopic surgery. With this procedure, there is less blood loss and patients are able to return to normal physical activity much faster.
- Urinary diversion with a bag outside the body: A surgeon uses intestinal tissue to create a path for urine to leave the body through an opening in the abdomen. This path is called a stoma. Its opening in the abdomen is covered by a bag that sits outside the body and catches the urine as it is released.
- Urinary diversion with a pouch inside the body: A surgeon uses intestinal tissue to create a reservoir called an Indiana Pouch and a path that leads out to the abdomen. The pouch collects urine inside the body. Several times a day, the patient uses a catheter, or soft tube, to connect to the path in the abdomen and empty urine in the pouch. Providence Saint John’s specializes in this procedure.
Chemotherapy may be used to treat bladder cancer before or after surgery.
It may be used to help:
- Shrink the tumor before surgery
- Keep you cancer-free after surgery
- Prolong life when surgery is not an option
You may receive chemotherapy in several ways:
- Into the bladder: After TUR for early bladder cancer, the doctor inserts a tube through your urethra to put a liquid drug in the bladder. This treatment may be given once a week for six weeks.
- By mouth: Some chemotherapy drugs are pills that may be given before or after surgery.
- By vein: For cancer that has invaded the muscle of the bladder or spread to other tissues, drugs are usually given intravenously.