Treatment

Treatments

There are different types of treatment for patients with bladder cancer, depending on the stage and grade of the cancer and the person’s overall health. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge.

Involvement in trials is up to the patient. Many of our doctors are principle investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for bladder cancer include surgery, radiation therapy, chemotherapy and biologic therapy. Clinical trials are testing many other approaches, some of which are becoming standard of care.

Surgery

Transurethral resection (TUR): In this surgery, a cystoscope (a thin, lighted tube) is inserted into the bladder through the urethra, and 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. Siteman is a world leader in experience with TURs.

Radical cystectomy: During this surgery, the bladder and nearby lymph nodes are removed. In women, a hysterectomy (removal of the uterus) would usually be performed at the same time because the uterus would lose its support. The urological cancer team at Siteman is one of the most experienced in the world in performing nerve-sparing bladder removal. For invasive bladder cancer, chemotherapy is often given before cystectomy.

Creation of a neobladder, a replacement bladder made out of intestinal tissue, is done.

Instead of creating an opening through the skin to divert urine, the surgeon places the new bladder in place of the cancerous bladder and connects it to the urethra.

This surgical technique allows both men and women to achieve nearly normal continence. Men who have nerve-sparing bladder removal and a neobladder can continue to have normal erections and urinate through their penis. Women also experience more comfortable sexual intercourse with a neobladder.

Neobladders are only appropriate for certain patients when the chances of recurrence are low and in the absence of other certain chronic conditions.

After surgery, some patients are given chemotherapy to lessen the chances the cancer will come back.

Radiation Therapy

Bladder cancer is often treated with radical surgical removal of the bladder.  However, in many circumstances a combination of radiation therapy and chemotherapy can allow bladder preservation with the same rates of cure.  New technologies such as MRI-guided radiation therapy are allowing radiation oncologists at Siteman to deliver radiation more precisely to the bladder, making the treatment more tolerable and effective.

Chemotherapy

Chemotherapy involves the administration of drugs, either orally or intravenously, to kill cancer cells. Recently, several new drugs have increased the options for physicians treating patients with bladder cancer. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given before or after surgery, in conjunction with radiation or by itself.

Medical oncologists at Siteman currently are investigating a series of new anti-cancer drugs that can be placed in the bladder, either in combination with standard medications or alone. Chemotherapy given through a catheter directly into the bladder is called regional therapy.

Biologic or immunotherapy: This treatment uses the patient’s own immune system to fight the cancer. After removing the cancer, the patient is treated with an intravesical biologic therapy called BCG (bacillus Calmette-Guérin), which is given in a solution that is placed directly into the bladder using a catheter for a brief period and repeated in a series of treatments.  In non-invasive bladder cancer, the biologic approach is usually a single remedy.

Chemoradiation: This treatment combines chemotherapy and radiation to increase the effects of both.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.