Bladder Cancer Treatment Options at Penn

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Different treatments are available for those with bladder cancer. Some treatments are called standard. This means they are the currently used treatments. Some treatments are being tested in clinical trials. A treatment clinical trial is a study meant to help improve current treatments or obtain information on new treatments.

When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. You may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment, while others are available during or after treatment.

Treatment options vary depending on your situation including the stage of the cancer and other factors that may be present.

Talk with your team about the approach that is best for you.

Treatment Options at Penn

Surgery

One of the following types of surgery may be done:

• Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
• Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. 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 to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
• Neobladder: When a radical cystectomy is performed, and if the cancer hasn't spread too far, it is often possible to create a new bladder, also called a neobladder, using tissue from the intestines. Neobladders are positioned inside the body in the same position as the original bladder. The kidneys will filter as they always did and deposit urine into the neobladder which holds the urine until the patient is able to release it. Many patients are able to learn how to control the release of urine from the neobladder much as they did with a normal bladder. If this is not possible, the patient must insert a catheter to empty the neobladder. This approach is possible if the patient has full kidney and liver function and no cancer in the urethra.
• Segmental cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
• Urinary diversion: Surgery to make a new way for the body to store and pass urine.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Types of radiation therapy include:

• External radiation (or external beam radiation) comes from a machine outside the body. The machine directs high-energy rays at the cancer and some normal surrounding tissue. It is the most often used radiation treatment. The machine used to deliver the high-energy rays is called a linear accelerator.

• Three-dimensional (3-D) conformal radiation treatment is a type of external beam radiation. It uses computers to allow doctors to more precisely target a tumor with radiation beams (using width, height, and depth).

• Intensity-modulated radiation treatment (IMRT). IMRT is a type of 3-D conformal radiation treatment that uses radiation beams (usually x-rays) of various intensities to give different doses of radiation, at the same time, to small areas of tissue. This allows the delivery of higher doses of radiation to the tumor and lower doses to nearby healthy tissue.

• Photodynamic therapy (PDT) combines a drug called a photosensitizer or photosensitizing agent with a specific type of light to kill cancer cells. Photosensitizers are drugs that when exposed to a specific wavelength of light,produce a form of oxygen that kills nearby cells. PDT can also work by shrinking or destroy tumors by damaging blood vessels in the tumor. This prevents the cancer from receiving nutrients. Also, PDT may activate the immune system to attack the tumor cells.

• Proton Therapy is the most precise form of radiation treatment for cancer possible, while minimizing damage to healthy tissue and surrounding organs.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic Therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Clinical Trials

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

New types of treatment are being tested in clinical trials at Penn.

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk that cancer will recur (come back).