Understanding Bladder Cancer 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.
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●    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
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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.

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Synergo Therapy: Explained

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​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.

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Cystectomy: Explained

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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.

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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.

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