What treatment has been effective for your bladder cancer?
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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.