Bladder Cancer Treatment Options

Bladder cancer treatment options - In a non-muscle invasive tumor, the following bladder cancer treatment options are required:

TUR
At a TUR, a hollow tube is inserted into the urethra, and through an instrument, the resector. This consists of a metal lint (a curved wire) that is brought to the tumor. With the help of electric current on this lens, the tumor is then cut into sections.

Returning tumor (recurrent)
After the tumor has been removed by means of a TUR, there is 60-70% chance of the disease returning within one year. This is called a recurrence. In addition, the more malignant the tumor is, the greater the chance of a recurrence. In principle, the tumor can be re-removed with a TUR. In order to reduce the risk of recurrence, an additional treatment in the form of bladder washings is often chosen.

Due to the likelihood of a recurrence, a cystoscopy is regularly performed at the outpatient clinic. In the first year after treatment every 3-4 months, thereafter every six months and finally annually.



Blow molding
If the superficial tumor often returns, then attempting to reduce the risk of return. This happens with bladder rinse. In addition, a tumor-inducing agent is introduced via a catheter, which then remains in the bladder for 1 hour. The medication used and the amount of bladder rinsing depends on the risk of tumor recurrence. The rinse takes place once a week for a period of six weeks. The follow-up treatment takes one to three years, where the drug is administered monthly to quarterly.

Medicinal choice in a bladder pool
In the case of bladder swallowing, there are two types of medication:

• Cell-coding and cell-curing inhibitors (cytostatics)
• Medications that stimulate a cancer response countermeasure (immunomodulators)

Side effects of bladder purging

• Depending on the medicine used, bladder swallowing may cause side effects. These can be the following:
• Often need to pee with a small amount of urine
• Pain during peeing
• Blood in the urine (red to brown discoloration by bleeding of the bladder mucosa)

After the last rinse, these side effects disappear almost immediately.

When using the immunomodulator BCG (originally a vaccine against tuberculosis, which also works with bladder cancer as immunotherapy), the following side effects also include:

• nausea
• bladder inflammation
• fever and flu-like symptoms

These side effects also disappear as soon as treatment is stopped. In some cases, the bladder fluid cure should be stopped prematurely due to the side effects. During the course, urinary tests are regularly conducted to exclude urinary tract infections. If there is a urinary tract infection, then this is first treated with antibiotics and the bladder rinse is given at a later date.

Laser treatment
Occasionally, when there are some minor recidivities observed in the bladder controls, those can be polyclinically laser wiped out. The treatment is performed with a cystoscope through the urethra. Anesthesia is not required here.



If there is a muscle-invasive tumor, then more thorough bladder cancer treatment options are required. One of the following treatments or combinations thereof will be chosen:

Operation (surgery)
In an operation through the stomach, bladder cancer surgical removal of all or part of the bladder. It is first examined whether there are enlarged lymph nodes in the pelvis that can indicate sowing. These lymph nodes are removed and directly examined by the pathologist directly. That's called a freezing cold investigation. When seeding is found, it may be decided to break the operation. If the lymph nodes are clean, the bladder is also removed. Men also remove the prostate with the vesicles, as well as the urethra if it is affected. Women also remove the uterus, urethra and possibly a piece of vaginal wall, depending on the tumor site; The reason for this is that these organs are close together and the urologist completely wants to remove the tumor.

Depending on the site in the bladder and the size of the muscle-infected tumor, it is possible in some cases to remove the tumor (called partial resection) followed by an internal irradiation. That's called brachytherapy. To this end, 4 hollow tubes inserted into the tumor site were inserted into the bladder wall followed by iridium irradiation. This radioactive substance is inserted through the hollow tubes as wire so that internal irradiation of the original tumor region can take place for 3-4 days.

When the entire bladder has to be removed, there are three possibilities for directing urine flow:

• The kidney urine drainage tubes can be inserted into a small intestine which is taken from the many meters of small intestine and then extends through the abdominal wall. That's called a urinary stoma and a urine collection bag is then necessary. (The operation by Bricker)
• A reservoir can be made from a small intestine with the beginning of the large intestine, in which the urine drainage conductors are attached with the opening of the reservoir in the abdominal wall. Based on the valve mechanism between the small and large intestine, this means that the urine remains in the reservoir and can be riped a number of times a day via a catheter (also referred to as dry stoma, the Indiana pouch)
• A small bladder is made of small or large intestine (neoplasia) attached to the urethra (here are various techniques available)

Radiation
An operation is not possible in all cases. For example, if the physical condition is too bad to remove the tumor operatively, external radiation may be transmitted.

Chemotherapy
If there is a saturation, the patient is treated with chemotherapy. The chance of healing is then low; Only about one in five bladder cancer patients respond favorably to chemotherapy.

*Image source : Healthline

References :

1. National Cancer Institute
2. Blaaskanker
3. American Cancer Society