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Understanding bladder cancer

Understanding Bladder Cancer Treatments

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​​Bladder cancer is the 4th most common malignancy among men, and the 13th most frequent among women. More than 330,000 new cases of bladder cancer are diagnosed worldwide every year. Approximately 75% of these cases are non-muscle invasive disease originating in the bladder wall lining (urothelium). This type of tumour tends to recur, mostly as non-muscle invasive cancer, despite treatment. A tumour that penetrates more deeply into the muscular layer of the urinary bladder is called “invasive” bladder cancer.



Number of new bladder cancer cases per year   

USA & Canada 76,749         

Europe 166,583         

Japan 22,042                    

UK 10,399     

Data taken from an evaluation by the World Health Organization (WHO) & Cancer Research UK 2011



The symptoms of bladder cancer, which are not necessarily clinically evident, generally include:   

• Visible presence of blood in urine (hematuria), which is generally painless.

• Evidence of blood in urine in laboratory tests.

• Urinary urgency (inability to postpone urination) and frequency (urinating often).

• Discomfort during urination.

 

These symptoms may also appear in other non-malignant diseases such as urinary tract infection, urinary bladder stones, benign tumours and others. Only a doctor can interpret the relevance of these symptoms, therefore the appearance of any one of these presentations requires medical attention.

Treatment options for non-muscle invasive bladder cancer

Molecules
Diagnosis and treatments

Upon being diagnosed with bladder cancer, your doctor and MDT team will ascertain the stage and grade of the disease, and then configure the most appropriate treatment plan based on those characteristics. Your doctor may use an instrument that enables direct visualisation inside the bladder, during a procedure called cystoscopy. During this procedure tissue samples of the bladder wall (biopsy) may be collected for examination under the microscope. In case of suspicion of tumour during cystoscopy, a surgical removal known as Transurethral Resection (TURBT) will normally follow. A tissue sample is usually necessary in order to determine the tumour (grade) and the extent to which it has penetrated into the bladder wall (stage). Your doctor may also need to refer you for further tests.

In the meantime, it’s important for you to know what treatment options are available and how your life will be shaped in the near future. 
 
The doctor will recommend the type of treatment based on the tumour’s characteristics and the patient’s condition. The decision as to the most appropriate treatment, its consequences and chance of success, will be explained by the doctor and medical team.

●    Surgical removal of tumour by TURBT
●    Chemotherapy
●    Immunotherapy
●    Synergo Therapy

●    Cystectomy
 
Surgical removal of tumour by TURBT
: Explained

 

This is an operation that is performed through the urethra, under regional or general anaesthesia with no need to open the abdominal cavity. In case of numerous tumours, the doctor may need to perform successive TURs or an extensive operation. Occasionally partial or complete (also called radical) removal of the urinary bladder is required (removal of the bladder is called cystectomy), especially when the tumour involves the muscle layer. In this case an alternative route for drainage of urine is then created.

Once the type of tumour is ascertained and the risk for recurrence and progression is evaluated, preventive therapy is usually administered by flushing the bladder with either a chemotherapeutic or a biological agent (bladder instillations, also called intravesical therapy).

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Chemotherapy: Explained

For treating bladder cancer, there are many different forms that chemotherapy can take. The most common are drugs that are injected into a vein. When in the bloodstream, these drugs stop the growth of cancer either by killing the cells or dividing them. 
Another common chemotherapy for non-muscle invasive bladder cancer patients is intravesical chemotherapy – chemo that is put into the bladder through a tube in the urethra. These treatments flush the bladder with drugs to kill the cells and lower the chances of recurrence.
For Synergo therapy, this is known as thermochemotherapy – a cooled chemotherapeutic agent which is flushed through the bladder while simultaneously and uniformly radiating the bladder walls with radiofrequency. This will be discussed in more detail below.
 
Immunotherapy: Explained

The immune system protects us from illness, disease, and infection, but sometimes it is not strong enough to kill cancer cells. Similarly, cancer cells can hide or escape from the immune system, and can even produce signals to stop it from attacking. 
Depending on your type and stage of cancer, however, immunotherapy might be used to boost the immune system and help the body fight back. 
 
The standard of care for most patients with non-muscle-invasive bladder cancer (NMIBC) is immunotherapy with intravesical Bacillus Calmette-Guérin (weakened live bovine tuberculosis bacteria), which activates the immune system to recognize and destroy malignant cells and has demonstrated durable clinical benefit.
Synergo Therapy: Explained

The Synergo device combines local radiofrequency, tissue thermal elevation of the bladder wall, and – as mentioned earlier – the flushing of the urinary bladder with with a cooled chemotherapeutic agent . The radiofrequency and chemotherapy are administered simultaneously and locally through a special transurethral catheter equipped with a miniaturised antenna.

Synergo therapy is carried out specifically for patients with non-muscle invasive bladder cancer, either for prophylactic treatment – the prevention of tumour recurrence – or ablation treatment – the destruction of the tumour. 
The former is for patients who have already undergone tumour removal surgery – TURBT – and the latter is for tumours that are difficult to remove in a single surgical procedure, patients who are unable to undergo surgery, or tumours that are frequently returning.

 

For both treatments, you will be treated with weekly one-hour sessions, without the need for any amnesia. 
Before each session, you’ll be asked to refrain from drinking excessive fluids, while after the session, it’s advised that you drink a lot of water, wash your hands thoroughly after urination, and wear protection for sexual intercourse for 24 to 48 hours. 
The side effects are typically mild – including local pain, increased frequency of urination, and a burning sensation during urination – and most disappear within around 48 to 72 hours. 
Your doctor will decide how many sessions you will need, depending on your individual circumstances, and once the initial weekly sessions are finished, further treatment will be given every 6 to 8 weeks. You will then continue with regular cystoscopies and tests as required.

Cystectomy: Explained

A treatment for those who at a very high risk of cancer spreading or coming back or for those with muscle-invasive bladder cancer is a cystectomy, which is a surgical procedure in which the bladder is partially or fully removed. Once removed, the urologist will replace it with an ileal conduit, a continent cutaneous diversion, or a neobladder.

An ileal conduit is a way to collect urine and allow it to exit from an opening in the skin called a stoma. A continent cutaneous diversion creates a reservoir out of your small and large intestines to store urine, with a ureters attached to one end, and a stoma connected to the other.

A neobladder is a secondary bladder created from the small intestine, with a ureter attached to one end, and the urethra connected to the other. This can be periodically emptied by relaxing the pelvic muscles and tensing the abdominal muscles.

The recovery time itself can take several weeks to several months, depending on the type of bladder removal surgery you undergo. During this time, those with an ostomy bag will be advised to eat a low-residue diet for a few months, wash the skin around the stoma regularly with warm water, and reduce skin irritation with ostomy powder.

Synergo therapy
What to Do After Your Diagnosis


As mentioned previously, the way forward for your treatment will be decided by your doctor and MDT team. Feelings of anxiety and tension are normal in this situation and family support is very important. It is advisable to prepare a written list of all questions troubling you, before reporting to your doctor, and for a family member to accompany you during the visit.
Upon learning the stage and grading of your cancer, the treatment will be determined in line with your individual case and risk factors, lasting a longer period or a shorter period depending on how advanced your bladder cancer is. 
This is an open dialogue, of course, which means you can ask your doctor about certain treatments and what you might qualify for. But it’s always best to trust your doctor’s judgement and remember that you’re in the best hands possible. 
For all treatments, there are plenty of things you can do to support your health, including a low-fat diet, exercising regularly, and sticking to a consistent, healthy sleeping pattern. 
You should also look into the numerous bladder cancer support groups that are out there, as these will help you to keep your stress and anxiety levels down, and can provide practical and emotional support for those suffering.

​Preparing for treatment .
Patient follow-up

Following treatment for bladder cancer, you will continue with regular follow-up cystoscopies and tests as required. It is essential to comply with the recommended follow-up schedule to ensure that any disease recurrence is identified as early as possible.

Support and follow-up

Disclaimer

The information above is not intended to contain a full and complete description of your condition and should only be viewed as a supplement to the information provided by your doctor. This above is not a substitute for professional medical advice and is to support and not to substitute the discussion between you and your doctor. While clinical studies support the safety and effectiveness of the Synergo System when used in the treatment of non-muscle invasive bladder cancer, results may vary. There are no guarantees of outcome. Before you decide on treatment options, discuss them with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Synergo treatment may not be appropriate for every individual; it may not be applicable to your condition. Consult with your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether Synergo is appropriate for your situation. The information presented is not a substitute for the good advice of the attending physician. It is intended to supply patients with available information, thus making the doctor-patient dialogue more efficient: Legal Disclaimer

DISCLAIMER
Bladder instillation with Synergo RF

The Synergo applicator (catheter) inserted through the urethra

The Synergo RF applicator

The Synergo applicator (catheter) situated inside the bladder: RF, chemotherapy and hyperthermia are uniformly distributed during treatment

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