Treatment Options for Bladder Cancer in India
Several treatment options are available for bladder cancer in India depending on the stage, and other factors like patient’s health and preference.
It involves the removal of cancer and surrounding tissues during operation. There are different types of surgery available depending on the stage and extent of cancer. Surgery options for bladder cancer include:
- Trans-Urethral Bladder Tumor Resection (TURBT): This procedure is used for diagnosing as well as treatment. During this surgery, a cytoscope (a narrow tube with a light and camera) is inserted through the urethra into the bladder. A small wire loop is attached to the end of cytoscope and is used to remove the abnormal tissues or burn the tumor with laser or high-energy electricity (fulgation). For TURBT, the patient is put under local anaesthesia. This is the most common treatment option for early-stage non-muscle invasive bladder cancer.
- Cystectomy: Removal of all or part of the bladder. This is performed when the cancer is invasive. It is of following types:
- Radial cystectomy: This surgery involves the removal of the entire bladder and nearby lymph nodes. This procedure is done when the cancer is large and has invaded the muscle wall. In men, prostate and seminal vesicles are the nearby organs that are removed during this procedure. While in women, the organs that are removed are a uterus, fallopian tubes, ovaries and part of the vagina. The surgeon then creates another way for passage of urine from the body.
- Partial cystectomy: Also known as a segmental cystectomy. Only a part of the bladder is removed along with the portion of the muscle layer that cancer has invaded. The main advantage of this surgery is that the patient gets to keep the bladder and can urinate normally after recovering from the operation.
- Laparoscopic cystectomy may be chosen by the surgeon, in which case, a small incision is made instead of a large one, and a tiny camera attached to one end of the instrument is used to see inside the pelvis. This is a minimally invasive surgery to remove the bladder and is performed by a surgeon who is experienced in this kind of operation.
- Urinary Diversion: Reconstructive surgery to create an alternative way to store and pass urine. Several types of surgeries can be performed depending on the medical situation and the patient’s preference. The three types are:
- Incontinent Diversion: For this, the surgeon removes a part of the intestine and connects it to ureters to create a passageway for urine to pass from the body. So, the urine flows through this passageway from the kidneys to outside of the body from an opening, called stoma, in the skin in front of the abdomen. The urine comes out continuously in small amounts and gets collected in a small bag placed over the stoma. In this procedure, there is no control over the flow of urine.
- Continent Diversion: In this approach, part of the small or large intestine is used to make a pouch which acts as urinary reservoir inside the body and one end of the pouch is attached to the stoma. A valve is created in the pouch which allows urine to be stored. This method is preferred by the patient as there is no need for a bag outside the body. Urine can be drained out by putting a catheter into the stoma.
- Neobladder: This is a newer method, in which the surgeon creates a new bladder (neobladder) from the piece of intestine and is attached to the urethra. This method routes the urine back into the urethra, thereby restoring urination. So the patient can pass out the urine normally.
This therapy involves the use of drugs to destroy cancer cells by stopping their ability to divide and grow. The therapy can be done with one anticancer drug or combination of different drugs at the same time (combination drug). Chemotherapy for bladder cancer is of two types:
- Intravesical chemotherapy: This treatment is for early stages of cancer and the chemo drug is administered directly into the bladder.
- Systemic chemotherapy: For this treatment, the drugs are given as a pill or injected into the vein, or muscle, through which it enters into the bloodstream and spread throughout the body.
This involves the use of high energy x-rays to kill cancer cells and stop them from growing. There are two types of radiotherapy:
- External-beam radiation: This is the most common type of radiation therapy, in which the machine outside the body is used to direct radiation precisely towards cancer.
- Internal-beam radiation/Brachytherapy: This therapy uses radioactive implants like needles, seeds, or catheters that can be placed near or directly into cancer.
- Radiation therapy, alone, or in combination with chemotherapy, is usually used after surgery (TURBT) to destroy any remaining cancer cells or as part of preliminary treatment for advanced stage cancer or to relieve symptoms caused by advanced bladder cancer like pain and bleeding.
Also known as Biological therapy. This therapy involves the use of medicine to boost a person’s immune system to help it recognize and fight against the cancer cells. It involves the use of substances produced by the body or in a laboratory to improve or target the immune system or restore function.
BCG vaccine is one of the examples of biological agents used in immunotherapy after TURBT procedure. Other drugs that are used are Atezolizumab, avelumab, nivolumab, etc. The drugs used are given as intravenous (IV) infusions, every 2 to 3 weeks.