Posted on February 4th, 2009 by
Surgery and chemotherapy are the main components in the treatment of bladder cancer.
Depending on your treatment plan, several different types of physicians may be involved in your care. These may include urologists, medical oncologists, and radiation oncologists. Urology is a medical specialty that focuses on care of the urinary tract in both men and women as well as male reproductive health.
Treatment of bladder cancer generally includes surgery. For patients with superficial bladder cancer, surgery often involves transurethral resection (TUR), the insertion of a surgical instrument through the urethra to remove the abnormal areas of the bladder lining. TUR may be accompanied by the delivery of immunotherapy or chemotherapy drugs directly to the bladder through a catheter in the urethra (intravesical therapy).1
Patients with deeper or more-extensive cancer may require a radical cystectomy and a urinary diversion.2 In women a radical cystectomy generally involves removal of the bladder and many adjacent organs, including the uterus, fallopian tubes, ovaries, and part of the wall of the vagina. Because more-extensive cancers may already have spread beyond the bladder, systemic (whole-body) chemotherapy may be administered before or after surgery.
A study published in the New England Journal of Medicine reported that patients with muscle-invasive bladder cancer who received chemotherapy prior to cystectomy had significantly better survival than patients treated with cystectomy alone.3 Some patients may be candidates for bladder-sparing treatment (also known as trimodality therapy), which involves TUR, systemic chemotherapy, and radiation therapy.4
Because the bladder is removed during a radical cystectomy, the surgeon must create an alternative way for urine to be stored and passed. There are different approaches to urinary diversion. Using one approach, the urine drains through a stoma (an opening in the skin) to a bag attached to the outside of the body. Using another approach, the urine collects in a pouch inside the body and is periodically emptied by passing a catheter through the stoma. It may also be possible to surgically re-create a bladder that connects to the urethra.
For patients with cancer that has spread from the bladder to distant sites in the body, chemotherapy is a common treatment.5 Because available treatments often have limited effectiveness in patients with metastatic bladder cancer, patients may wish to consider participating in a clinical trial of new therapeutic approaches.
Finally, it is important to note that bladder cancer has a high rate of recurrence. Patients who have been diagnosed with bladder cancer will need to be regularly monitored for recurrence after treatment is completed.
2 Bladder Cancer (PDQ®): Treatment. Health Professional Version. National Cancer Institute Web site. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/HealthProfessional. Accessed April 9, 2007.
3 Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. New England Journal of Medicine. 2003;349(9):859-66.
4 Pashos CL, Botteman MF, Laskin BL, et al. Bladder cancer: epidemiology, diagnosis, and management. Cancer Practice. 2002;10(6):311-22.
5 Bladder Cancer (PDQ®): Treatment. Health Professional Version. National Cancer Institute Web site. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/HealthProfessional. Accessed April 9, 2007.
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Tags: Bladder Cancer
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