Advanced Treatment for Bladder Cancer - Best Cancer Hospital in India

INITIAL BLADDER CANCER TREATMENT

The most common first treatment of non-muscle invasive bladder cancer is surgery to remove any abnormal appearing areas inside the bladder; this is called transurethral resection of bladder tumor (TURBT).

Transurethral resection of bladder tumor (TURBT) — Transurethral resection of bladder tumor (TURBT) is a procedure in which a physician uses a cystoscope to see inside the bladder and remove any abnormal-appearing areas. A cystoscope is a long thin tube that contains a light and a camera.

In most cases, this procedure is done in an operating room while the person is under anesthesia. After the procedure, you can usually go home, sometimes with a catheter for a few days.

In certain cases, usually in people with more aggressive microinvasive cancers, a second TURBT will be performed several weeks after the first to be sure that no tumor was missed during the original cystoscopy. If there are new areas that appear abnormal, they will be removed. If there are no new abnormal-appearing areas, you will begin adjuvant therapy.

BLUE LIGHT (FLUOROSCENT) CYSTOSCOPY

Enhanced visualization of tumors and improved removal can be accomplished with the advent of a cystoscopy procedure using ultraviolet (blue) light together with a dye that is injected into the bladder at least an hour beforehand. Usually performed while a patient is under anesthesia, this FDA-approved dye and procedure is gradually gaining increased acceptance in the United States, although it has been in use in Europe for over a decade. The main advantage appears to be about a 20 to 25 percent increased detection of tumors or carcinoma in situ (CIS) that is not seen under standard white light cystoscopy. This also helps define the margins of the bladder tumor for complete removal.

 Use of blue light cystoscopy results in a 10 to 15 percent absolute decrease in tumor recurrence at about two years. A similar technological advance does not require a dye at all but uses blue green filters to highlight areas of increased blood vessels often feeding the tumor. This technique is called narrow band imaging or NBI and can be done in the office with a flexible cystoscope. While not as rigorously studied as blue light cystoscopy, the results of clinical trials show a similar degree of increased tumor detection compared to standard white light cystoscopy.

ADJUVANT BLADDER CANCER THERAPY

Even in people who have their bladder tumor completely removed with TURBT, up to 50 percent of people will have a recurrence of their cancer within 12 months. Because of this high recurrence rate, adjuvant (additional) therapy is usually recommended. The type of adjuvant therapy recommended depends upon your risk of recurrence:

●Some people who are at low risk of recurrence will be advised to have a single dose of intravesical chemotherapy at the time of the initial TURBT. This is thought to help prevent floating tumor cells dislodged from the TURBT to seed and start new tumors. 

"Intravesical" means that the treatment is put inside of the bladder, usually through a catheter (a flexible tube passed through the urethra, where urine exits). This allows a high concentration of the treatment to be applied directly to the areas where tumor cells could remain, potentially destroying these cells and preventing them from reemerging in the bladder and forming new tumors.

●Some people who are at intermediate risk of recurrence will be advised to have either a full six-week course of intravesical chemotherapy, most commonly mitomycin.

●People at high risk of recurrence or worsening will be advised to start intravesical BCG, usually within two to six weeks of the first treatment. This is most commonly followed by additional booster treatments (maintenance therapy) once a complete response is obtained. Occasionally, however, patients are advised to consider bladder removal (cystectomy) especially if the disease is extensive.

Intravesical chemotherapy — Chemotherapy refers to the use of medicines to stop or slow the growth of cancer cells. The most commonly used intravesical chemotherapy for bladder cancer is mitomycin. This is put inside the bladder in one of two ways:

●One regimen involves giving the mitomycin once, immediately after TURBT. The solution is left in the bladder for 30 to 60 minutes, then allowed to drain out through a catheter.

●Alternately, the mitomycin can be given on a weekly basis for six weeks. With this regimen, the bladder is filled with mitomycin with a catheter, the solution is left for one to two hours, then the person urinates. A maintenance treatment may be given once per month for up to one year.

Intravesical BCG — Bacillus Calmette-Guerin (BCG) is a live bacterium related to cow tuberculosis. It is a common treatment for non-muscle invasive bladder cancer, particularly for cancers that have a risk of worsening over time. BCG is believed to work by triggering the body's immune system to destroy any cancer cells that remain in the bladder after TURBT.

BCG is in a liquid solution that is put into the bladder with a catheter. The person then holds the solution in the bladder for two hours before they urinate. The treatment is usually given once per week for six weeks, starting approximately two to three weeks after the last TURBT. Further booster (maintenance) treatments can extend the benefit of BCG.

Benefits of intravesical BCG — Intravesical BCG, in combination with TURBT, is the most effective treatment for non-muscle invasive bladder cancer. BCG therapy has been shown to delay (although not necessarily prevent) tumor growth to a more advanced stage, decrease the need for surgical removal of the bladder at a later time, and improve overall survival .