As BCG supplies decrease, patients living with bladder cancer require effective alternatives for treatment. This guideline covers bladder-preserving chemoradiation therapy which may improve survival and quality of life outcomes.
Bladder cancer is usually detected when someone detects blood in their urine. Once detected, the cancer may be classified as low-grade or muscle-invasive depending on how deeply it has spread within the bladder wall.
1. Chemotherapy
Chemotherapy uses medications to either kill or slow the growth of cancer cells. Treatment usually entails taking a combination of drugs over several months over multiple cycles, with blood tests performed prior to each one to check on your health and kidney function as well as hospital sessions using catheter-delivered chemotherapy inserted via your bladder via the urethra for systemic therapy treatment.
Your doctor may suggest preoperative chemotherapy therapy or neoadjuvant chemotherapy before surgery to help shrink tumors and minimize tissue removal during recovery. This form of chemotherapy treatment, known as preoperative therapy or neoadjuvant chemotherapy, may also be combined with radiation treatments (chemoradiation) in treating muscle-invasive bladder cancer that has not spread beyond its bladder wall into other parts of the body.
Our doctors are nationally-recognized for their innovative research using new chemotherapy drugs and immunotherapy therapies to treat bladder cancer. We are conducting tests of combinations of therapies, looking for more effective yet less side-effect-inducing therapies if possible; should you qualify, we may offer you participation in one of our clinical trials.
Patients suffering from superficial bladder cancer confined to the urothelium and lamina propria of their bladder may benefit from intravesical chemotherapy therapy, using an implanted catheter in your urethra that delivers chemotherapy directly into your bladder – this method is commonly referred to as bladder sparing therapy.
Invasive bladder cancer is typically treated with neoadjuvant chemotherapy followed by radical cystectomy; however, due to their age or other medical comorbidities they may opt for bladder preservation techniques instead.
Perlmutter Cancer Center experts are national leaders in developing bladder preservation strategies for patients with bladder cancer. With experience using various techniques such as cryoablation and radiofrequency ablation, as well as developing innovative approaches like bladder-preserving neoadjuvant chemotherapy for NMIBC as well as definitive bladder sparing definitive treatment with either chemoradiation, nivolumab+gemcitabine+doxorubicin (Adriamycin), our experts at Perlmutter are at the forefront of developing strategies to preserve bladder preservation strategies when treating patients with NMIBC.
Cisplatin is an established treatment option for muscle-invasive cancer. We conducted a national study which demonstrated that when combined with radiation therapy, cisplatin significantly reduces the risk of cancer recurrence after surgery compared with either therapy alone; and this finding has been corroborated through long-term follow up studies.
2. Radiation
Radiation may provide an alternative treatment option for some patients suffering from non-muscle invasive bladder cancer (NMIBC), especially if their cancer does not penetrate muscle. Radiation uses high-energy x-rays to kill cancer cells or stop their spread when used alone or combined with chemotherapy. A radiologist will use imaging tests to locate your tumor before targeting radiation treatment to it precisely; you will need to empty your bladder prior to each treatment session as well as lie down during it (which typically lasts 10-15 minutes). Your first session, known as simulation, will include gathering images tests in order to plan your radiation therapy plan in advance.
Trials comparing radical radiotherapy (RT) with cystectomy as treatments for advanced bladder cancer demonstrated that both techniques were equally effective at prolonging survival without necessitating extensive bladder removal – also known as bladder-preserving therapy.
This approach may be especially helpful for those too frail or unwilling to undergo surgery; or who simply want to avoid undergoing bladder removal procedures altogether. Unfortunately, bladder-preserving therapy’s local recurrence rate is high and its ability to control symptoms like haematuria, dysuria, frequency and nocturia often falls short.
Multiple trials have been undertaken to increase symptom control and decrease side effects from this form of treatment. One such method is daily adaptive radiation therapy (DART), which adjusts doses each day in order to protect normal tissue from too much radiation exposure – an important improvement as radiation may have serious adverse side effects if too much bladder surface area is exposed.
Transurethral resection with fulguration is another treatment option for NMIBC that uses electrical current to burn away tumors through transurethral resection. It’s minimally invasive and can often be performed right in your doctor’s office without incisions being necessary; combined with chemotherapy, radiation therapy or immunotherapy to lower chances of recurrence; this combination therapy is known as adjuvant therapy.
3. Immunotherapy
Vaccines and immunotherapy drugs work by stimulating your immune system to combat cancer. Your doctor may suggest this therapy as part of the treatment for bladder cancer; studies are ongoing, but early findings show promise in lengthening people’s lives with less severe side effects than other therapies.
Checkpoint inhibitors are among the most promising immunotherapy drugs. These medicines target proteins that prevent your immune cells from attacking cancer cells more efficiently; in turn, this enables your body to kill cancer cells more effectively and may speed recovery from metastases or recurrent bladder cancers. They have now been approved by regulatory authorities as treatments.
If your bladder cancer is nonmuscle invasive (NMIBC), meaning that it has not invaded the muscle layer of the bladder wall, intravesical chemotherapy could be an option for treatment. Your doctor will discuss a treatment plan based on factors like your risk of returning cancer and what type of NMIBC it is.
Intravesical chemotherapy involves injecting drugs directly into your bladder via your urethra, reaching only cells lining its interior without having as much effect on cells in other parts of your body as with intravenous (IV) chemotherapy treatments. Common chemotherapy drugs used include fluorouracil and doxorubicin; other options might include cyclophosphamide or vinblastine depending on your doctor.
BCG can also help treat NMIBC. BCG is a vaccine made of bacteria, designed to stimulate your immune system so it can attack any cancerous cells found within your bladder and destroy them effectively.
The FDA has approved several combinations that combine chemotherapy with BCG or other immunotherapy drugs for improved results compared to using either one alone. These combination therapies, known as combination therapies, have shown better outcomes than BCG alone.
Some combination therapies utilize drugs that target the PD-1 and PD-L1 immune checkpoints, binding to these proteins to keep them from impeding your immune system’s ability to kill cancer cells. They have been approved as treatment options for advanced metastatic bladder cancer that recurs after chemotherapy as well as those who cannot receive platinum-based therapies due to other health conditions; researchers are exploring ways of making them even more effective.
4. Surgery
Surgery may be an option for people diagnosed with bladder cancer. The procedure takes place either at a doctor’s office or hospital and an anesthetic is administered, followed by placement of a plastic tube (catheter) into their bladder during surgery to collect urine for collection purposes during procedure.
After surgery, healthcare professionals may provide medication through a catheter to aid the bladder in healing faster. Medication could prevent infection or reduce pain post-op; after several days post-surgery, however, the doctor might remove the catheter.
Patients undergoing surgery often need to stay in a hospital for at least several nights following their procedure, as complications from their operation such as breathing issues, fever, blood clots and confusion as well as difficulty with urination or defecation (constipation) could arise post-surgery.
Before most surgeries, individuals take off all clothing and don a hospital gown. Next, health care providers scrub the skin that will be operated upon with antiseptic to protect it against infection during surgery and cut away hair at the site of operation.
Certain surgeries, known as invasive procedures, require healthcare providers to cut into the skin in order to perform surgery. Before any such invasive procedures take place, they should fully inform patients of its benefits, risks, and any possible side effects.
Chemotherapy involves the use of drugs to kill cancer cells or stop their spread, with some types more dangerous than others and leading to potentially more severe side effects – including those related to your heart, blood vessels and nerves. Most adverse reactions typically appear within several weeks after starting chemotherapy treatments.
Some chemotherapy medicines are administered using a catheter placed directly into the bladder. This may result in chemical cystitis – inflammation of the bladder wall – as well as kidney issues. Chemotherapy drugs can damage tissue in other parts of your body such as bladder, bowel or bone marrow as well as make new blood cell production harder for bone marrow to produce; these effects are known as systemic toxicity; symptoms may include hair loss, diarrhea and fever.
