Treatment for bladder cancer, like other tumors, includes standard and clinical trial therapies. The so-called clinical trial therapies are clinical investigational treatments using new or improved older technologies.
Currently, the four standard therapies for bladder cancer include surgery, radiation therapy, chemotherapy and immunotherapy. Early stage patients are treated with surgery and paired with intravesical bladder immunotherapy. For patients with intermediate and advanced stages, the combination of surgery and chemoradiotherapy is the main treatment.
According to the stage, malignancy, pathological type and size of tumor, location and involvement of adjacent organs, the following three surgical procedures are available: (1) local resection and electrocautery of bladder tumor, mostly performed through cystoscopy. It is suitable for papillary tumors of the bladder that only infiltrate the mucosa or submucosa, have low malignancy and have a thin basal tip.
(2) Partial cystectomy is suitable for invasive papillary carcinoma of more limited scope, located away from the bladder triangle and neck area. Most of the bladder can be preserved and the patient can still urinate normally after the surgery.
(3) Total cystectomy is suitable for tumors with large scope and scattered multiple tumors that are not suitable for local excision; tumors located near the bladder triangle; or invasive tumors located in the bladder neck. During surgery, the prostate and seminal vesicles are usually removed in men, while the uterus, ovaries and part of the vagina are removed in women. After the entire bladder is removed, a urinary diversion is performed and the surgeon usually uses the bowel to create a pathway to store and excrete urine.
Radiation therapy includes both external and internal radiation, but the use of radiation as a single treatment for bladder cancer is not ideal and is currently used primarily for palliative care for patients with advanced tumors, or as a lay-in treatment for patients undergoing surgery or chemotherapy.
In the case of bladder cancer, chemotherapy is mainly administered by intracavitary infusion chemotherapy and subabdominal arterial cannulation chemotherapy, which is directly applied to tumor cells and has much less side effects than systemic drugs. For intermediate and advanced stage patients, systemic drugs may be required.
Biologic therapy can be used to fight tumors by activating, enhancing, and modulating the patient’s own immune system. BCG infusion is commonly used to prevent and treat bladder cancer.
In addition to standard therapies, there are new approaches that are in the clinical trial stage that patients can choose from. Some of the common ones are as follows: Heat therapy: Cancer cells are afraid of heat and a temperature higher than body temperature (43°C) can inhibit the growth of cancer cells while leaving normal tissues undamaged.
Photosensitization therapy: A therapy that uses light energy to stimulate specific drugs to work and kill cancer cells.