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==Overview==
==Overview==
The predominant therapy for bladder cancer is [[surgical resection]]. Adjunctive [[chemotherapy]], [[radiation therapy]], and [[immunotherapy]] may be required.
==Medical Therapy==
==Medical Therapy==
===Radiation therapy===
'''Immunotherapy'''
(Also called radiotherapy) uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.
 
A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.


Doctors use two types of radiation therapy to treat bladder cancer:
* [[Immunotherapy]] is a type of biological therapy that uses the immune system to help destroy cancer cells.<ref name="pmid19711266">{{cite journal |vauthors=Ghahestani SM, Shakhssalim N |title=Palliative treatment of intractable hematuria in context of advanced bladder cancer: a systematic review |journal=Urol J |volume=6 |issue=3 |pages=149–56 |date=2009 |pmid=19711266 |doi= |url=}}</ref>
* Bacillus Calmette–Guérin (BCG)
:* [[Immunotherapy]] by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial [[tumors]].<ref>{{Cite journal|author=Alexandroff AB, Jackson AM, O'Donnell MA, James K |title=BCG immunotherapy of bladder cancer: 20 years on |journal=Lancet |volume=353 |issue=9165 |pages=1689–94 |date=May 1999 |pmid=10335805 |doi=10.1016/S0140-6736(98)07422-4}}</ref>
:* BCG is a [[vaccine]] against [[tuberculosis]] that is prepared from attenuated live ''[[Mycobacterium bovis]]'', that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard [[chemotherapy]].<ref>{{Cite journal|doi=10.1056/NEJM199110243251703|title=A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder|year=1991|last1=Lamm|first1=Donald L.|last2=Blumenstein|first2=Brent A.|last3=Crawford|first3=E. David|last4=Montie|first4=James E.|last5=Scardino|first5=Peter|last6=Grossman|first6=H. Barton|last7=Stanisic|first7=Thomas H.|last8=Smith Jr|first8=Joseph A.|last9=Sullivan|first9=Jerry|last10=Sarosdy|first10=Michael F.|last11=Crissman|first11=John D.|last12=Coltman|first12=Charles A.|journal=New England Journal of Medicine|volume=325|issue=17|pages=1205–9|pmid=1922207|pmc=1164610}}</ref>
:* The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.
'''Chemotherapy'''


*External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants.
* Intravesical [[chemotherapy]]
*Internal radiation: The doctor places a small container of a radioactive substance into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during this treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body.
:* During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.<ref>Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015 </ref><ref name="pmid26604440">{{cite journal |vauthors=Porten SP, Leapman MS, Greene KL |title=Intravesical chemotherapy in non-muscle-invasive bladder cancer |journal=Indian J Urol |volume=31 |issue=4 |pages=297–303 |date=2015 |pmid=26604440 |pmc=4626913 |doi=10.4103/0970-1591.166446 |url=}}</ref>
:* Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.<ref name="pmid18369709">{{cite journal |vauthors=Shen Z, Shen T, Wientjes MG, O'Donnell MA, Au JL |title=Intravesical treatments of bladder cancer: review |journal=Pharm. Res. |volume=25 |issue=7 |pages=1500–10 |date=July 2008 |pmid=18369709 |pmc=2440939 |doi=10.1007/s11095-008-9566-7 |url=}}</ref>
:* [[Mitomycin]] is the drug most often used in intravesical chemotherapy.<ref name="pmid20562793">{{cite journal |vauthors=Volpe A, Racioppi M, D'Agostino D, Cappa E, Filianoti A, Bassi PF |title=Mitomycin C for the treatment of bladder cancer |journal=Minerva Urol Nefrol |volume=62 |issue=2 |pages=133–44 |date=June 2010 |pmid=20562793 |doi= |url=}}</ref><ref name="pmid20205607">{{cite journal |vauthors=Williams SK, Hoenig DM, Ghavamian R, Soloway M |title=Intravesical therapy for bladder cancer |journal=Expert Opin Pharmacother |volume=11 |issue=6 |pages=947–58 |date=April 2010 |pmid=20205607 |doi=10.1517/14656561003657145 |url=}}</ref>


===Chemotherapy===
* Systemic chemotherapy
Uses drugs to kill cancer cells. The doctor may use one drug or a combination of drugs.
:* During systemic chemotherapy, the drugs are given intravenously.
:* Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.<ref name="pmid26984414">{{cite journal |vauthors=Rose TL, Milowsky MI |title=Improving Systemic Chemotherapy for Bladder Cancer |journal=Curr Oncol Rep |volume=18 |issue=5 |pages=27 |date=May 2016 |pmid=26984414 |doi=10.1007/s11912-016-0512-2 |url=}}</ref>
:* Chemotherapy is recommended before a radical [[cystectomy]] (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to [[lymph nodes]].<ref name="pmid25404954">{{cite journal |vauthors=Teply BA, Kim JJ |title=Systemic therapy for bladder cancer - a medical oncologist's perspective |journal=J Solid Tumors |volume=4 |issue=2 |pages=25–35 |date=2014 |pmid=25404954 |pmc=4232954 |doi=10.5430/jst.v4n2p25 |url=}}</ref>


For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.
'''Radiation therapy'''


If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.
* [[Radiation therapy]] may be the main treatment for people who can’t have surgery.<ref name="pmid15815960">{{cite journal |vauthors=Konski A, Feigenberg S, Chow E |title=Palliative radiation therapy |journal=Semin. Oncol. |volume=32 |issue=2 |pages=156–64 |date=April 2005 |pmid=15815960 |doi= |url=}}</ref>


The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay.
* [[External beam radiation therapy]] is the type of radiation treatment that is most often used to treat bladder cancer.<ref name="pmid1556049">{{cite journal |vauthors=Kaufman DS, Shipley WU, Althausen AF |title=Radiotherapy and chemotherapy in invasive bladder cancer with potential bladder sparing |journal=Hematol. Oncol. Clin. North Am. |volume=6 |issue=1 |pages=179–94 |date=February 1992 |pmid=1556049 |doi= |url=}}</ref>


===Biological therapy===
* Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.<ref name="pmid26756029">{{cite journal |vauthors=Byun SJ, Kim JH, Oh YK, Kim BH |title=Concurrent chemoradiotherapy improves survival outcome in muscle-invasive bladder cancer |journal=Radiat Oncol J |volume=33 |issue=4 |pages=294–300 |date=December 2015 |pmid=26756029 |pmc=4707212 |doi=10.3857/roj.2015.33.4.294 |url=}}</ref>
(Also called immunotherapy) uses the body's natural ability (immune system) to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. This helps prevent the cancer from coming back.


The doctor may use intravesical biological therapy with BCG solution. BCG solution contains live, weakened bacteria. The bacteria stimulate the immune system to kill cancer cells in the bladder. The doctor uses a catheter to put the solution in the bladder. The patient must hold the solution in the bladder for about 2 hours. BCG treatment is usually done once a week for 6 weeks.
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 14:27, 7 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

The predominant therapy for bladder cancer is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required.

Medical Therapy

Immunotherapy

  • Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells.[1]
  • Bacillus Calmette–Guérin (BCG)
  • Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial tumors.[2]
  • BCG is a vaccine against tuberculosis that is prepared from attenuated live Mycobacterium bovis, that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy.[3]
  • The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.

Chemotherapy

  • During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.[4][5]
  • Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.[6]
  • Mitomycin is the drug most often used in intravesical chemotherapy.[7][8]
  • Systemic chemotherapy
  • During systemic chemotherapy, the drugs are given intravenously.
  • Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.[9]
  • Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.[10]

Radiation therapy

  • Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.[13]

References

  1. ↑ Ghahestani SM, Shakhssalim N (2009). "Palliative treatment of intractable hematuria in context of advanced bladder cancer: a systematic review". Urol J. 6 (3): 149–56. PMID 19711266.
  2. ↑ Alexandroff AB, Jackson AM, O'Donnell MA, James K (May 1999). "BCG immunotherapy of bladder cancer: 20 years on". Lancet. 353 (9165): 1689–94. doi:10.1016/S0140-6736(98)07422-4. PMID 10335805.
  3. ↑ Lamm, Donald L.; Blumenstein, Brent A.; Crawford, E. David; Montie, James E.; Scardino, Peter; Grossman, H. Barton; Stanisic, Thomas H.; Smith Jr, Joseph A.; Sullivan, Jerry; Sarosdy, Michael F.; Crissman, John D.; Coltman, Charles A. (1991). "A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder". New England Journal of Medicine. 325 (17): 1205–9. doi:10.1056/NEJM199110243251703. PMC 1164610. PMID 1922207.
  4. ↑ Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015
  5. ↑ Porten SP, Leapman MS, Greene KL (2015). "Intravesical chemotherapy in non-muscle-invasive bladder cancer". Indian J Urol. 31 (4): 297–303. doi:10.4103/0970-1591.166446. PMC 4626913. PMID 26604440.
  6. ↑ Shen Z, Shen T, Wientjes MG, O'Donnell MA, Au JL (July 2008). "Intravesical treatments of bladder cancer: review". Pharm. Res. 25 (7): 1500–10. doi:10.1007/s11095-008-9566-7. PMC 2440939. PMID 18369709.
  7. ↑ Volpe A, Racioppi M, D'Agostino D, Cappa E, Filianoti A, Bassi PF (June 2010). "Mitomycin C for the treatment of bladder cancer". Minerva Urol Nefrol. 62 (2): 133–44. PMID 20562793.
  8. ↑ Williams SK, Hoenig DM, Ghavamian R, Soloway M (April 2010). "Intravesical therapy for bladder cancer". Expert Opin Pharmacother. 11 (6): 947–58. doi:10.1517/14656561003657145. PMID 20205607.
  9. ↑ Rose TL, Milowsky MI (May 2016). "Improving Systemic Chemotherapy for Bladder Cancer". Curr Oncol Rep. 18 (5): 27. doi:10.1007/s11912-016-0512-2. PMID 26984414.
  10. ↑ Teply BA, Kim JJ (2014). "Systemic therapy for bladder cancer - a medical oncologist's perspective". J Solid Tumors. 4 (2): 25–35. doi:10.5430/jst.v4n2p25. PMC 4232954. PMID 25404954.
  11. ↑ Konski A, Feigenberg S, Chow E (April 2005). "Palliative radiation therapy". Semin. Oncol. 32 (2): 156–64. PMID 15815960.
  12. ↑ Kaufman DS, Shipley WU, Althausen AF (February 1992). "Radiotherapy and chemotherapy in invasive bladder cancer with potential bladder sparing". Hematol. Oncol. Clin. North Am. 6 (1): 179–94. PMID 1556049.
  13. ↑ Byun SJ, Kim JH, Oh YK, Kim BH (December 2015). "Concurrent chemoradiotherapy improves survival outcome in muscle-invasive bladder cancer". Radiat Oncol J. 33 (4): 294–300. doi:10.3857/roj.2015.33.4.294. PMC 4707212. PMID 26756029.

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