Bladder Cancer

TREATMENT OPTIONS

Superficial Bladder Cancers

The primary treatment includes a transurethral resection of the bladder tumor. In some cases, intravesicular treatment with BCG or other chemotherapy agents is used to help decrease the risk of local recurrence.

Cystectomy, or complete removal of the bladder, is reserved for patients with multiple tumors, multiple recurrences, or a poorly functioning bladder.

Muscle Invading Bladder Cancers

Non-Bladder Sparing Treatment

Non-bladder sparing treatment consists of a radical cystectomy. This is indicated when patients are non-amenable to a partial resection, have a poorly functioning bladder, have high-grade disease associated with Tis, or have multicentric or frequent recurrence of low-grade disease. In some instances, preoperative (or postoperative) radiotherapy is used. There is no clear role for the adjuvant use of chemotherapy.

Bladder Sparing Treatment

Bladder sparing treatment includes surgical and nonsurgical approaches. Partial cystectomy is indicated for a solitary tumor located in the dome of the bladder so that adequate margins can be obtained. There is no previous history of transitional cell carcinoma, there is no associated carcinoma in situ, and there is normal bladder functioning. Transurethral bladder tumor resections with and without postoperative radiotherapy could be considered as well. There is very limited data on this type of treatment. Alternatively, the use of radiotherapy alone, chemotherapy alone, or a combination of the two has been used. The most promising results have been obtained with combined modality therapy consisting of chemotherapy and radiotherapy after maximal transurethral resection of the tumor. Four prospective randomized trials have shown survival rates equivalent to that of cystectomy. Of those who did well with the treatment, the majority maintained an adequately functioning bladder. For patients with metastatic disease both chemotherapy and palliative radiation can be used for treatment. Radiation offers very good palliation of bleeding and pain.