In order to reduce the risk of urinary bladder cancer recurrence and progression, all patients that have had a TURBT have to undergo Intravesical Immunotherapy and/or Intravesical chemotherapy which is usually given immediately after surgery.
In an exclusive interaction with OnlyMyHealth editorial team, Dr. Rajesh Kota, Consultant – Medical Oncology & Haematology at American Oncology Institute, Vijayawada explains stage wise treatment of urinary bladder cancer. Here is what he shared with us.
Treatment plan for non-muscle invasive disease (stage 0a, stage 0is, stage I)
At these early stages, the tumor is confined to the superficial layer of the bladder wall (mucosa) and does not invade the muscle of the bladder. The main goal of the treatment at this stage is to remove the local tumor by surgery during a TURBT. However, additional treatment delivered locally in the urinary bladder (called adjuvant, intravesical treatment) is recommended since it lowers the risk of the tumor recurring or progressing.
Cystectomy is usually recommended for patients with stage 0 and stage I tumors that do not respond to adjuvant intravesical treatment.
The treatment plan for muscle-invasive bladder cancer (stage II, stage III)
At these stages, the tumor has invaded the muscle layer of the bladder or has extended through the bladder wall into the tissues surrounding the bladder. Therefore, the treatment aims to surgically remove the entire bladder as well as the lymph nodes in the pelvis and the neighboring organs. The procedure is called radical cystectomy.
For male patients, radical cystectomy involves the complete removal of the bladder, all visible tumor tissue, but also the urethra, prostate, seminal vesicles, the lower parts of the ureters and the lymph nodes in the pelvis. Whereas, for female patients, this involves removal of the bladder, all visible and resectable tumors, the entire urethra, the lower part of the ureters, the adjacent vagina, the uterus and the lymph nodes in the pelvis.
Radical cystectomy often causes the loss of bladder function, that is, the storage of urine. The surgeon will therefore connect the ureters to a new outlet to allow evacuation of urine (called a urinary diversion). This new outlet may be either the urethra, the skin of the abdomen, or the very last part of the large bowel (called a rectosigmoid diversion).
Prior to surgery, chemotherapy is administered with the aim to reduce the tumor size, attack tumor cells in metastases that are too small to be detected and reduce the risk that tumor cells will spread to other parts of the body during surgery.
Radiotherapy alone may be indicated for patients who are medically not fit enough to undergo the extensive surgery of radical cystectomy. Radiotherapy may be given as part of combination treatment in selected cases where the treatment aims to preserve the bladder.
The treatment plan for advanced and metastatic disease (stage IV)
At this stage, the tumor has grown through the bladder wall into the wall of the pelvis or the abdomen, or beyond the abdomen to some of the distant organs. Since it is difficult to remove the tumor completely at this stage, the primary goal of the treatment is to target tumor cells using chemotherapy or immunotherapy.
Follow-up after treatment
After completion of treatment, the doctor will propose a follow−up, aiming to detect and prevent adverse effects of the treatment, detect possible recurrence as soon as possible and direct appropriate treatment. The follow-up protocol depends on the grade and staging of the bladder tumor that was treated, and on the type of treatment given.