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Bladder Cancer: Treatment Options By Stage [I to IV]

The bladder cancer treatment depends on the stage, grade, location, number, the performance status of the patient, along with other factors.

Following are the preferred treatment approaches for different stages of bladder cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

Bladder Cancer - Treatment (Localised Disease) - Infographic
Bladder Cancer - Treatment (Localised Disease)
Bladder Cancer - Treatment (Locally Advanced Disease) - Infographic
Bladder Cancer - Treatment (Locally Advanced Disease)
Bladder Cancer - Treatment (Metastatic Disease) - Infographic
Bladder Cancer - Treatment (Metastatic Disease)
STAGE TNM TREATMENT
0 TNM Transurethral resection with clear margins is considered preferred treatment approach. The patient may be given intravesical chemotherapy to prevent disease recurrence.
I TNM In case of low grade disease, transurethral resection with complete removal of all cancer cells followed by intravesical chemotherapy is considered as the first choice of treatment.
In case of high grade disease where transurethral resection cannot achieve complete removal of cancer cells, cystectomy (a partial or completed removal of the bladder) is considered as the preferred treatment approach.
II T2a-2b N0 M0 When transurethral resection indicates muscle-invasive disease, radical cystectomy (see description) is considered as the standard treatment. Few patients may be treated with partial cystectomy (see description). Addition of chemotherapy before (preferred) or after surgery is recommended.
In patients who are not good candidates for cystectomy, radiotherapy with or without chemotherapy may be employed.
IIIA T3-4a N0 M0

T1-4a N1M0
Radical cystectomy (see description) is considered as the standard treatment. Addition of chemotherapy before (preferred) or after surgery is recommended.
In patients who are not good candidates for cystectomy, radiotherapy with or without chemotherapy may be employed.
IIIB
IVA
T1-4a N2-3 M0

T4b Any N M0

Any T Any N M1a
Chemotherapy with/without radiation therapy is the preferred initial treatment and the further decision is taken depending on the response to initial treatment.
IVB Any T Any N M1b Chemotherapy is the mainstay of treatment in case the disease has spread to distant body parts/organs.
Palliative therapy to relieve symptoms and improve the quality of life may be employed.

Following is the brief description of various options employed for colon cancer:

  1. Surgery: Surgery is the treatment of choice for muscle-invasive and some higher stage bladder cancers that have not spread to distant body parts and can be completely removed.

    Partial cystectomy can be performed, depending on location and number of tumor(s), which allows the patient to retain bladder function. However, a complete cystectomy is generally required for higher stage disease, wherein the entire bladder and nearby lymph nodes are generally removed.In radical cystectomy, prostate and seminal vesicles are also removed in men, while the ovaries, fallopian tubes, uterus, cervix, and a small portion of the vagina are often removed in women.

  2. Intravesical Therapy: In this technique, drug is placed directly into the bladder using a catheter. It can produce local action without affecting other body parts.

    Drugs like mitomycin, valrubicin, docetaxel, thiotepa, and gemcitabine can be given by this technique. Bacillus Calmette-Guerin (BCG) (a modified tuberculosis bacterium) can also be given by this technique, which acts by activating the body’s immune system to destroy cancer cells. The most common side effects associated with intravesical therapy is irritation/burning in the bladder.

  3. Chemotherapy: Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for advanced stage disease that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects due to its effect on normal body cells apart from cancerous cells.

  4. Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy). It is commonly used in conjunction with chemotherapy for the treatment of advanced-stage bladder cancer to prevent recurrence. It may sometimes be used for palliation of symptoms such as pain, bleeding, etc.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes the patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals of treating bladder cancer:

  • Prolongation of life
  • Reduction of symptoms
  • Improvement of overall quality of life

Watch the video below to understand the treatment of Localised and Locally advanced bladder cancer.

And in the following video, CancerBro explains the treatment of metastatic bladder cancer.

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