Bladder Cancer - Effective Treatment

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What is the treatment of superficial bladder cancer?

Superficial bladder cancer is a cancer which has not invaded the muscle wall of the bladder and is confined to the inner lining of the bladder. The T stage is Ta, T1, or Tis (also known as carcinoma in situ or "CIS"). After the initial TURBT or biopsy in case of CIS, the subsequent treatment in these cases may involve observation with regular follow-up with cystoscopy examinations of the bladder, instillation of medications in the bladder, or in certain cases, surgical removal of the bladder (radical cystectomy).

Small low-grade, superficial bladder cancers may not require aggressive management after the initial TURBT and may be simply followed up by doing repeated cystoscopy examinations at regular intervals (usually every three months for the initial two years and then at increasing intervals). Recurrent tumors may be surgically removed or fulgurated (burnt out) with special instruments passed through the cystoscope. It is very important to note that 30% to 40% of these tumors tend to recur and these recurrences may not be associated with any symptoms. Hence, it is imperative to stick to a regular follow-up protocol to ensure that the disease does not go out of control. It has also been shown that a single dose of a chemotherapy medication (for example, mitomycin C [Mutamycin]) put inside the bladder immediately after a TURBT can decrease the chances of recurrence within the first two years after surgery.

High-grade, larger, multiple, or recurrent superficial bladder cancers may require additional treatment after the initial TURBT. One of the most effective and widely used medications is called the Bacille Calmette Guerin, commonly referred to as BCG. It is a modified form of a bacterium that causes tuberculosis in cattle (Mycobacterium bovis). It is instilled into the bladder in the form of a solution using a catheter placed in the urinary passage. It acts by stimulating the immune system of the body to act against the cancerous bladder cells and prevent their growth and development. It has been shown to decrease the chances of recurrence of bladder cancer as well as its invasion into the muscle layer of the bladder. However, it is only partially effective in achieving these objectives and its use does not obviate the need for a regular follow-up. It is usually administered in six initial doses at weekly intervals followed by a "maintenance" schedule which is usually recommended for at least once per year but may be needed for as long as three years.

Patients, who do not respond to BCG treatment, recur in spite of treatment or those who have medical issues which preclude the use of BCG, may require other forms of treatment. These include bladder instillation of immunotherapy agents such as Interferon or chemotherapy medicines like valrubicin (Valstar), mitomycin C, epirubicin (Ellence), or doxorubicin (Adriamycin). In general, these medications are not as effective as BCG and help only a small minority of patients who have not responded to BCG.

In patients who have an aggressive form of high-grade superficial bladder cancer and those who have not responded or recurred in spite of treatments mentioned above, a more aggressive form of treatment may be warranted. This is usually in the form of a major surgical procedure called radical cystectomy. It entails removal of the bladder and the prostate and diverting the urinary stream using parts of the intestine. This surgery will be described in the subsequent section on treatment of invasive bladder cancer.

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Comment from: royrogers, 55-64 Male (Patient) Published: December 02

March 2002 I found I had bladder cancer. After procedure it retuned 9 months later. It returned again in 9 months. Started chemo and it came back in 3 years. Procedure and chemo again it came back in 2 years. 90 days later it is back again. 7 procedures, 34 tumors removed 9 rounds of poison and I am still kickin' and still have my bladder intact in December 2010.

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Comment from: 75 or over Female (Patient) Published: July 23

I had heavy blood in my urine for a week before finally going to a doctor in the fall of 2006 when I reached a point of total blockage. A cysto showed a tumor, which was removed a month later and diagnosed as a superficial cancer. The doctor thought it had all been removed, but a biopsy several weeks later showed cancer cells remaining. I started six weeks of BCG, which I was told is very effective and it worked for me. Only two of the treatments gave me minor side effects that didn't last beyond the day of treatment. Another biopsy in the hospital a few weeks after the last treatment didn't show any remaining cancer cells. I had a cystoscopy every three months for a year after the last BCG treatment, and then every four months for another year. I'm now on a six month cysto and annual CT scan schedule for another two and a half years, and I have been cancer free so far. I know it can recur, but BCG worked very well for me, as it does for countless others. I'm 75 and had ovarian cancer many years ago. I'm keeping my fingers crossed the bladder cancer doesn't recur. I have other medical issues and deal with things one at a time. I don't dwell on it and can't spend my life worrying about it. Several medical professionals told me that BCG is highly effective and can be used repeatedly, so I trust it will work for me again if there's a recurrence. Obviously, I hope that won't be necessary, but it beats most of the alternatives.

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