Overview of Treatment Options

There are a variety of treatment options available to treat bladder cancer. However, the treatment option depends on the level of progression of the cancer. A combination of treatments may also be used. Treatment options include surgery, radiotherapy, chemotherapy, immunotherapy, target drugs and clinical trials.

Surgery

Overview of Surgery Options

Transurethral resection of bladder tumor

A surgical procedure involving the removal of the tumor from the bladder through the urethra. This surgery is commonly done on early stages of bladder cancer. It can also be completed on other stages before other treatments as a bladder-preserving surgery.

The procedure involves a cystoscope being inserted into the urethra and into the bladder.  The surgeon uses the cystoscope with a small wire tool and a laser to remove the tumor.

Urinary Diversion

A urinary diversion is a reconstructive surgery used to create a new method for the body to store and remove urine. This surgery occurs after the removal of the bladder. There are two types of urinary diversions that can occur: incontinent diversion and a continent diversion.

Incontinent diversion is where urination is no longer controlled. The ureter is attached to the intestine, and then leaves through an opening in the abdominal wall. After the procedure, urine is collected in a small bag worn outside the body.

Continent diversion is where urination is controlled. There are two methods that are used; Indiana pouch and orthotopic neobladder.  The Indiana pouch involves a pouch being made on the right side of the colon and a piece of the intestine. To drain the urine, a tube is inserted manually several times a day. In an orthotropic neobladder, a pouch is made from the small intestine. The ureters and urethra are attached and urination can occur normally. However, there are more complications involved within this surgery.

Cystectomy

A surgical procedure involving the removal of part or the entire bladder

Radical Cystectomy: The removal of the entire bladder, surrounding lymph nodes and ureters. This procedure is completed if the cancer has spread into the muscle layer. In women, the cervix, uterus, and anterior wall may also be removed. In men, the prostate and seminal vesicles may be removed. Men may experience erectile dysfunction, and women may experience sexual dysfunction post-surgery. As the bladder has been removed, your surgeon will create a new method to hold and pass urine out of the body. Please refer to the section Urinary Diversion.

Partial Cystectomy: The removal of part of the bladder with the cancer. This surgery is commonly done for early stages of bladder cancer, if the cancer has not spread to the lining. The surgeon does not need to create a new method for urine flow. Patients are able to urinate normally after recovery from this surgical procedure.

Pelvic lymph node dissection (PLND): This surgery is completed as part of the partial and radical cystectomy. It involves the removal of the lymph nodes from the pelvis. The lymph nodes may have cancer, or are at high risk and need to be removed.

Post- Surgery

After your bladder cancer surgery, your body will take time to recover. It is very important to follow your physician’s post-surgery instructions to ensure you do not have any complications after surgery.

Nutrition: After bladder cancer surgery, your diet is important for recovery. Drinking at least 8 glasses of water per day will keep the kidneys clear and your stools softer. Liquids are easier to digest and better for healing on the bowels. Soups and stews are excellent meals for consuming vegetables and liquids. Eating frequently small meals will be easier for healing the bowels. It is best to avoid fats and high-fiber foods for a few weeks post-surgery as your bowels heal.

Bowel Care: To allow the bowel to heal, it is important to not put any strain on your switches, having a soft stool is very important. To ensure that you have a soft stool, taking frequent walks and drinking water will help. Your physician may recommend taking a stool softener, eating fiber and drinking water.

Exercise: Taking frequent walks (even to the other side of the room) can help your recovery. Your body will take time to return to its regular pace. Walking is the best form of exercise for your recovery.

Chemotherapy

A cancer treatment that uses drugs that target and kill cancerous cells in the body. Chemotherapy can be taken orally through a pill, in an IV in the muscle, or placed into the bladder. Chemotherapy may be used in combination with another treatment like surgery to preserve parts of the bladder. Intravesical chemotherapy is where the drug is directly placed into the bladder. A tube is inserted through the urethra into the bladder for 2 hours. This type of chemotherapy only occurs for early stages of bladder cancer where the cancer has not spread to the wall of the bladder. Systemic chemotherapy is used if the cancer has spread to the wall of the bladder or other parts of the body.

Current Drugs: The FDA has approved these chemotherapy drugs for the treatment of bladder cancer.

• Atezolizumab
• Avelumab
• Balversa
• Bavencio
• Cisplatin
• Doxorubicin Hydrocholride
• Durvalumab
• Erdafitinib
• Imfinzi
• Keytruda
• Nivolumab
• Opdivo
• Pembrolizumab
• Tecentriq
• Thiotepa
• Valrubicin
• Valstar

Radiation Therapy

Radiation Therapy focuses external beams on the tumor to kill the cancer cells. It can be used along with chemotherapy to treat bladder cancer when the tumor has spread into the muscles of the bladder. There are two types of radiation therapy that can be used; internal and external. External is the type of radiation used for bladder cancer. External radiation uses a machine outside the body to send radiation into the bladder and surrounding tissues.

Immunotherapy

This type of cancer treatment is aimed at boosting the body’s immune responses against cancerous cells.  An immunotherapy drug can be directly placed into the bladder through the urethra for a few hours for 6 weeks. Immunotherapy drugs that are placed directly in the bladder are only treatment options for early stages of bladder cancer. It can also be given after a transurethral resection of the bladder tumor surgery. Common immunotherapy drugs include bacillus Calmette – Guerin and interferon alfa-2b