The bladder is a triangle-shaped organ that stores and passes urine for excretion. It is connected with the kidney through the ureter and to the outside via the urethra. The uncontrolled growth of cells in the bladder causes bladder cancer. This growth can remain confined, known as superficial or nonmuscle invasive bladder cancer, or spread to the bladder wall or other organs, termed muscle-invasive bladder or advanced bladder cancer. Based on the stage, the survival rate for bladder cancer varies.
The treatment depends upon the stage of bladder cancer. Here is a detailed insight into the most preferred treatment method at different stages of bladder cancer-
It is marked by cancer in the inner lining of the bladder. A combination of TURBT and intravesical therapy treats stage 0 cancers. TURBT, or Transurethral Resection of Bladder Tumour, is the method to diagnose and treat urinary tract cancer. The treatment in TURBT is done by fulguration, which involves killing cancer cells through an electric current. Doctors can use electrocautery or laser for it. Following this method, intravesical therapy is performed within a day through immune action or drugs.
The latter procedure is called intravesical chemotherapy and is preferred in low-grade or slow-growing cancer. For fast-growing cancer, intravesical immunotherapy is performed to target the immune cells in the body to kill the cancer cells. Both methods incorporate injections directly into the bladder. The treatment time and follow-up vary and may last around one year or longer.
The characteristic of stage 1 bladder cancer is that it spreads into the connective tissue layer. At this stage, cancer hasn’t reached the muscle layer. TURBT and fulguration, starting from Stage 1, are done to identify the extent of cancer.
The intravesical Immuno or chemotherapy follows depending on the low or high grade. Some cases might require radical cystectomy. Radiation therapy is also less preferred if cystectomy can not be performed.
Stage 2 indicates cancer has moved to the muscular layer as well. This stage also follows primary exposure to TURBT. The main treatment options are radical or partial cystectomy (complete or a part of the bladder is removed).
Radical cystectomy is preferred with chemotherapy, and this combination has shown an increase in survival rates. Besides the bladder, the surrounding lymph node is also removed. Few cases require radiation or chemotherapy specifically for lymph nodes as well.
The medical team decides the type of combination of mentioned therapies according to the patient’s health, age, and other relevant factors. The follow-up treatment type and duration after mentioned procedures depend on the recurrence chances.
Stage 3 is characterized by cancer in nearby bladder regions, such as tissues, organs, and lymph nodes. The combination of treatments here is TURBT, chemotherapy, and radical cystectomy.
Partial cystectomy is the very last option. Radiation therapy is again the least considered. Chemotherapy kills and shrinks cancer, saving other organs of the body. It is followed by surgery to remove the bladder.
If the cancer cells remain or reoccur, a different combination is used based upon the preference to kill the cells and halt the further spread. Immunotherapy is also considered at this point.
It indicates the spread of cancer to other organs. These are challenging to treat. Chemotherapy is usually the first option of treatment at this stage. The response to the first chemo decides the subsequent steps involving repetition of chemo and the correct time and combination for suitable treatment methods involving radiation therapy and cystectomy.
Surgery may often not give better results. Hence, in association with other methods, it is aimed to slow cancer growth, increasing life expectancy, and ease the symptoms. A urinary diversion is also an option, however, aimed to help urine flow to prevent kidney damage. Doctors also recommend clinical trials for new approaches to treat cancer, which may bring more relief and positive results.
Progressing or Recurring Bladder Cancer
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Treatment for bladder cancer may not be able to stop its progress. It may also come back after successfully removing or killing cancer cells. In any case, the new treatment plan is devised according to the health, age, previous treatment methods, extent of spread of cancer, and the patient’s will to continue treatment. Clinical trials may also pose a better option for the patient or future patients.
In advanced stages or certain situations, the complete removal of cancer may not be possible. Hence, the aim of treatment needs to be understood and decided to carry on or not. BLK Max hospital is an institution of excellence with a Tumour Board for discussion among multispeciality surgeons and oncologists to decide the best combination of available bladder cancer treatment methods for the patients. With years of expertise, the latest equipment, the multitude of clinical trials, and JCI accreditation, they strive to provide long life and pain relief.
Bladder cancer is treatable with a high success rate on timely diagnosis. Combined with numerous therapies, surgeries are key to killing and removing cancer cells.
Dr. S Hukku, Dr. Sajjan Rajpurohit, Dr. Aditya Vidushi, and a large team of doctors at BLK Max Hospital which is considered the Best Cancer Hospital in Delhi bring their expertise and experience in different fields together for the treatment of bladder cancer.
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