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Bladder Cancer Treatment

Introduction
Treatment for bladder cancer depends on the stage of the disease (particularly how deeply the cancer has invaded the bladder wall), the grade of the cancer, the patients’ general health, and other factors. People with bladder cancer are often treated by a team of specialists, which may include a urologist/urosurgeon, oncologist and radiologist. The doctors develop a treatment plan to fit each patient’s needs. Depending on its stage and grade, bladder cancer may be treated with.

Doctors may recommend one treatment method or a combination of methods. It is important for patients to discuss the treatment plan with their doctors.

Surgery
Surgery is a common form of treatment for bladder cancer. Early (superficial) bladder cancer may be treated at the time of diagnosis through a procedure called trans–urethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer or to burn away cancer cells with an electric current (fulguration). TUR requires anesthesia and may be done in the hospital.

Surgery to remove part or all of the bladder is called cystectomy. The most common form of surgery for invasive bladder cancer is radical cystectomy. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder.

Radical cystectomy removes the entire bladder, the nearby lymph nodes, and any surrounding organs that contain cancerous cells. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery may be performed to remove only the bladder to relieve urinary symptoms caused by the cancer. When the bladder must be removed, the doctor creates another way for urine to leave the body. (See Side Effects of Treatment and Rehabilitation). In some cases, patients may have a part of the bladder removed in an operation called segmental or selective cystectomy. This type of surgery may be done when a patient has a low–grade cancer that has invaded the wall of the bladder but is limited to one area of the organ. Since most of the bladder remains intact, a patient urinates normally after recovering from this surgery.

Radiation Therapy
In radiation therapy (also called Radiotherapy), radiation is used to destroy cancer cells. Like surgery, radiation therapy is a locally acting therapy. It affects cancer cells only in the treated area. Sometimes, radiation is administered before or after surgery, or along with anti–cancer drugs. When bladder cancer has spread to other organs, radiation therapy may be used there as well.

Radiation may come from a source outside the body (external radiation) or from a small container of radioactive material, called a radiation implant, placed directly into the bladder (internal radiation). Some patients have both kinds of radiation therapy.

External radiation therapy is usually administered on an outpatient basis in a hospital or clinic five days a week for five to seven weeks. Treatment may be shorter when external radiation is administered along with radiation implants.

For internal radiation, radiation implants are placed in the bladder either through the urethra or during surgery. The patient stays in hospital for several days while the implant is in place. To protect others from exposure to radiation, patients may not be able to have visitors or may have visitors for only a short time. Once an implant is removed, there is no radioactivity in the body. Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells. The doctor may use one drug or a combination of drugs. Chemotherapy may be used alone, or after TUR with fulguration to treat superficial bladder cancer. In a treatment called Intra–vesical chemotherapy, anti–cancer drugs are placed in the bladder through a tube called a catheter, which is inserted through the urethra. When given in this way, the anti–cancer drugs, which remain in the bladder for several hours, affect mainly the cells of the bladder. The treatment is usually followed once a week for several weeks. The treatment can continue once or several times a month upto a year depending upon the stage of the cancer developed in the bladder.

Chemotherapy is also used to help control the disease when cancer cells have deeply invaded the bladder or spread to the lymph nodes or other organs. In this case, the anti–cancer drugs are usually administered by injection into a vein (IV), some may be given orally. This form of chemotherapy is Systemic Therapy, meaning that drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Chemotherapy may be used alone or in combination with surgery or radiation therapy.

Biological Therapy
Biological therapy (also called immuno–therapy) is a form of treatment that uses the body’s natural ability (immune system) to fight cancer. Biological therapy for bladder cancer is most often used when the disease is superficial. Like chemotherapy, biological therapy may be used alone, to treat bladder cancer or after TUR (Trans–Urethral resection) with fulguration to help prevent the cancer from recurring. This form of treatment involves placing a solution of BCG, a substance that stimulates the immune system, into the bladder. The medicine stays in the bladder for about two hours before the patient is allowed to empty the bladder by urinating.

This treatment is usually done once a week for about six weeks and may need to be prolonged or repeated. Doctors are also studying the use of other forms of biological therapy for other stages of bladder cancer.


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