Bladder Cancer Treatment Options
The Cancer Institute offers patients thorough, comprehensive and state-of-the-art treatment options for bladder cancer. Our highly experienced bladder cancer specialists have significant expertise in treating all types of bladder cancers. For more than 20 years, Doylestown Health urologists have successfully performed hundreds of complex procedures ordinarily not available at community hospitals, including radical cystectomy and urinary diversion.
In addition, we take a personalized approach to care by supporting patients with a urologic cancer patient navigator. This highly trained, certified professional supports patients every step of the way from diagnosis through survivorship, and serves as a resource for care coordination and education on diagnosis and treatment options so they can make informed decisions about their care.
In general, bladder cancer is considered non-muscle invasive or muscle-invasive:
- Non-muscle invasive bladder cancer: The majority of bladder cancers, or 75 percent, are non-muscle invasive. These bladder cancers are highly treatable, have not spread and are in the early stages of the disease. Non-muscle invasive bladder cancer is generally managed through minimally invasive surgical techniques, or surgery in combination with chemotherapy or other infusion and therapeutic options.
- Muscle-invasive bladder cancer: Approximately 25 percent of bladder cancers are muscle-invasive, meaning the cancer has spread beyond the bladder walls to muscles, lymph nodes or other organs. This type of bladder cancer usually requires advanced surgery. Patients with this form of bladder cancer may need their bladder partially removed or entirely removed, followed by reconstructive surgery to create a urinary diversion. Our goal is to identify the treatment option with the highest likelihood of success, taking into account each patient's quality of life and avoiding damage to other organs.
Treatment Options for Non-Muscle Invasive Bladder Cancer
An initial diagnosis of bladder cancer, confirmed by a cystoscopy or advanced imaging tests, may require more tests to determine staging, such as bone scan, chest X-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI). For non-muscle invasive cancer, our urologists may recommend one or more of the following treatments to control, contain or eliminate the disease:
Transurethral resection of bladder tumor (TURBT) is the primary surgical approach for treating non-muscle invasive bladder cancers. During the TURBT procedure, an endoscope or thin, tube-like device is inserted in the urethra and into the bladder. A special wire loop removes abnormal tissues or tumors that are sent to the pathology lab for examination. Our urologists and surgeons develop a comprehensive care plan, based on these findings.
Intravesical installations are types of infusion therapies during which anti-cancer drugs are administered directly into a patient's bladder. Patients receive this treatment during follow-up visits in their urologist's office. These therapies may include:
- Chemotherapy: These specialized drugs are administered intravenously or directly into the bladder through your urethra, a process called intravesical therapy. Treatment usually involves a combination of two or more drugs and may be part of the plan of care that includes surgical, radiation or targeted therapies.
- Immunotherapy: This therapy usually takes place two to three weeks after the TURBT procedure to reduce the risk of progression or recurrence of the disease. Immunotherapy uses certain parts of the body's immune system to fight cancer cells using intravesical therapy. The most effective immunotherapy agents for bladder cancer are Bacillus Calmette-Guerin (BCG) used in combination with interferon alfa.
Penn Radiation Oncology Doylestown is an outpatient radiation treatment program located in The Pavilion at Doylestown Hospital, on the hospital's main campus. As a Penn Radiation Oncology satellite location, we are equipped with the most advanced technology available, including a state-of-the-art linear accelerator, a computer-controlled device that delivers radiation treatment, and offer direct referral to advanced radiation therapies available nowhere else in the region.
Patients with bladder cancer may receive radiation therapy on an as-needed basis to stop cancer cells from dividing and growing, or to shrink the tumor. Our urologists work closely with board-certified Penn radiation oncologists to treat patients with bladder cancer using advanced radiation therapies including external beam radiation, which is administered outside the body, or brachytherapy, during which a device is placed inside the bladder for radiation treatment.
In addition to these treatment options for bladder cancer, Doylestown Health's Cancer Institute's specialists utilize additional treatment options called neoadjuvant or adjuvant therapies. Neoadjuvant therapy is given before the main type of treatment to increase the likelihood of successful response or to shrink the tumor. Adjuvant therapy is given after the main type of treatment to lower the risk that cancer will return, or to increase the likelihood of cure. Often, doctors use a combination of approaches to treat bladder cancer including surgical treatment, infusion therapies and radiation therapies.
Treatment Options for Muscle-Invasive Bladder Cancer
Doylestown Health is one of a few community-based health systems in the Philadelphia region with more than 20 years of success performing complex surgical approaches to treat muscle-invasive bladder cancer, which affects 25 percent of patients diagnosed with the disease. At Doylestown Health, we offer every surgical treatment option for bladder cancer, from traditional open abdominal incision to new techniques such as robotic-laparoscopic surgery, which uses smaller incisions and computer-assisted devices.
Treatment options for muscle-invasive bladder cancer include:
- Partial cystectomy: This procedure may be an option for a small percentage of people when cancer has invaded the muscle but is small and confined to one place in the bladder. This surgery removes part of the bladder instead of the entire bladder. Lymph nodes are often removed at the same time to determine if cancer has spread. The advantage of this surgery is that the patient keeps a portion of their bladder and does not require reconstructive surgery; however, there is still a concern that bladder cancer can recur in the portion that is kept intact.
- Radical cystectomy: This is major surgery that removes the entire bladder and surrounding lymph nodes. In addition, the prostate and seminal vesicles are removed in men. In women, the uterus, ovaries, fallopian tubes and part of the vagina are also removed. Reconstructive surgery or urinary diversion is necessary immediately following radical cystectomy so that urine can successfully exit the body.
- Urinary diversion: After radical cystectomy, our surgical team creates a new route for urine to exit the body, called a urinary diversion. Surgeons may use three different options for this part of the procedure, depending on extent of cancer and the patient's health and personal preferences. All options are available to Doylestown Health patients and include:
- Ileal conduit: This procedure creates a passageway for urine to pass from the kidneys to outside of the body. Surgeons take a short piece of the intestine and connect it to the ureters to create a passageway that connects to the abdominal wall through an opening called a stoma or urostomy. The urine drains into the synthetic pouch or urostomy bag that is attached to the abdominal wall.
- Cutaneous continent urinary diversion: This procedure creates a valve in a pouch made from a piece of the intestine that allows urine to be stored and emptied in an internal reservoir. Urine is drained through a drainage tube or catheter in the stoma through the valve.
- Continent neobladder: This more complex method routes urine back into the urethra to create a urinary reservoir made of part of the intestine. The neobladder is sewn into the urethra and lets the patient urinate normally.
Surveillance for Recurrence in Bladder Cancer Survivors
While the prognosis or chance of control or cure for non-muscle invasive bladder cancer is positive, bladder cancer frequently recurs. Non-muscle invasive bladder cancers require regular checkups, surveillance and follow up screening for several years to prevent recurrence. The primary tests used for surveillance are cystoscopy, cytology, bladder biopsy and urine-DNA tests. Doylestown Health urologists generally recommend cystoscopy screening at different time periods during the months and years after the initial diagnosis and treatment.
Patients with aggressive cancers may undergo more frequent screening for bladder cancer recurrence. Surgery for muscle-invasive and more aggressive forms of bladder cancer usually requires removal of lymph nodes to detect their involvement with cancer. This helps doctors to decide if further treatment is needed after surgery, such as chemotherapy. It also impacts the chances of bladder cancer recurrence. Some data suggests that patients who undergo a more extensive removal of lymph nodes have a better chance for cure as opposed to others who do not have lymph nodes removed or at a lesser extent.
Reduce Your Risk for Bladder Cancer Recurrence
There are no guaranteed prevention strategies for bladder cancer recurrence; however, patients can discuss with their physician what proactive approaches are best for them. Strategies to reducing risk of bladder cancer recurrence may include:
- Quitting smoking
- Drinking plenty of fluids, especially water
- Eating a daily diet filled with fruits and vegetables
- Testing well water for arsenic
- Taking antioxidant vitamins
- Using precaution with chemicals in the workplace