Treatment recommended by your physician depends on the type of bladder cancer you have: transitional cell carcinoma (TCC), squamous cell carcinoma or adenocarcinoma. The stage of the cancer is also related to the therapeutic method used. Usually, the treatment of a bladder cancer diagnosed at early stages is less rigorous than that of a final stage bladder cancer. However, whatever the type or the severity of the cancer, bladder cancer treatment always involves surgery, radiotherapy, immunotherapy or chemotherapy; sometimes, a combination of those therapies can be used.
A less aggressive cancer that is confined within the wall of the bladder can be treated by endoscopic resection. This method consists of removing cancerous tissue from the bladder using an instrument called resector. A bladder cancer that has already metastases can be treated with cystectomy associated with chemotherapy combining several drugs. Usually, the surgery involves partial or total removal of the bladder.
Partial Cystectomy – this is a segmental resection of the bladder which allows you to get rid of the tumor while maintaining a normal natural urination. After the operation, the bladder capacity is reduced, but a normal capacity is recovered in a few months. In general, a partial cystectomy is indicated for bladder cancer located only on the bladder wall, which do not affect surrounding organs or tissues. The partial cystectomy, however, is associated with risk of recurrence. radiotherapy can be combined to reduce the risk of recurrence.
Total cystectomy (in men): this surgical procedure involving a complete removal of the bladder and other tissues surrounding it: the fatty tissue around the bladder, prostate, seminal vesicles, and possibly the urethra.
Total cystectomy (in women) – in women, a total cystectomy consists of removing the bladder and urethra, the fatty tissue around the bladder, uterus and part of the anterior wall of the vagina. The removal can be performed through the vaginal or abdominal area. In general, a reconstruction of the vagina after a total cystectomy is necessary.
These operations may cause a continual flow of urine which needs to be collected in a small plastic bag stuck to the skin of your abdomen. the bag must be changed regularly. If you wear an artificial bladder, you must learn to hold urine and control the discharge. Occasionally, you can experience some episodes of incontinence, which occurs mostly at night.
In addition, the removal of the bladder almost always causes impotence in men and infertility in women.
Radiotherapy is the use of high-energy beams to kill cancer cells. In general, two types of radiation are used in the treatment of bladder cancer, internal radiation therapy and/or external radiotherapy.
External radiation therapy – in external beam radiotherapy, cancer cells of the bladder are exposed to the radiation source. The rays of the radiation prevent the proliferation of the cancerous cells and cause their destruction. External radiation therapy can be administered before surgery to reduce the size of the tumor or after surgery in combination with chemotherapy.
Internal radiotherapy – during internal radiation, a radiation therapist places radioactive implants directly into the bladder to destroy the cancer cells. Unlike external beam radiation, internal radiation therapy requires a short hospitalization and visits are often not allowed to protect visitors from the radiation. In some cases, your oncologist can use both types of radiation: internal radiotherapy therapy and external radiotherapy.
Whether internal or external, radiation always causes at least one of these side effects:
- loss of appetite
- decreased sexual desire
- dryness and redness skin at the radiation site.
Chemotherapy is a systemic treatment that affects the entire organism. Depending on the aggressiveness of the tumor, your oncologist may use chemotherapy alone or in combination with radiation or surgery. The chemotherapy drugs can be administered intravenously or as local treatment.
Local chemotherapy – this therapy involves introducing chemotherapy drugs directly into the bladder, in order to destroy the cancer cells. Local chemotherapy is less toxic, causing fewer side effects. However, it is only effective in less advanced cancer or cancer that has been excised by a partial cystoscopy.
General chemotherapy – this method is systematic, drugs affect all organs of the body, thus causing more side effects. Systematic chemotherapy is generally used in the treatment of advanced bladder cancers or cancers that are untreatable by local chemotherapy.
Systematic chemotherapy increases your survival chance; however, it is still prone to side effects; the most common include:
- hair loss
- shortness of breath
- mouth sores.
Immunotherapy, also called biological therapy, immunotherapy is based on the iterative intravesical administration (administered directly into the bladder) of Bacille Calmette-Guerin (BCG) or interferon alpha 2a. These drugs are, most of the times, recommended in non-invasive cancers, after surgery. The purpose of the immunotherapy is to fortify your immune system, and help your body to destroy the cancer cells.