The type and nature of bladder cancer treatment will be determined according to the type of disease, the stage of the disease, and its degree. The treatment is selected through a multidisciplinary team of doctors, which includes urologists who are experts in bladder surgery, oncologists who are experts in the treatment of bladder cancer, as well as pathologists who review the biopsy samples and determine the stage and degree of the disease.
Treatment of local carcinoma (in situ)
The cancer of the very early bladder may develop rapidly. Therefore, the treatment will be concentrated and will begin with surgical removal of the tumor in the bladder. After surgery, chemotherapy is given or training (immunological) therapy in BCG into the bladder (details below). About 60-70% of patients are cured of the disease as a result of this therapeutic process.
Treatment of superficial cancer of the bladder
Superficial cancer can be a single tumor or several tumors. In most cases, superficial cancer will be removed by endoscopic surgery using a laparoscope. If necessary, chemotherapy or immunosuppressive (immunological) therapy will be given after surgery into the bladder (details below), to reduce the risk of recurrence of the disease.
Small papillary-type tumors in the bladder can be easily excised, by surgery by removing a tumor in the bladder through the urethra (turbt, transurethral resection of a bladder tumor). This is an endoscopic surgery using a resectoscope, which is inserted into the bladder.
During the operation, the tumor is excised at its base and the area is burned with the help of a weak electric current, to reduce bleeding. Through this surgery, it is possible to treat several tumors at the same time.
The operation is performed under anesthesia and lasts about 20-60 minutes. If necessary, immediately after surgery, chemotherapy will be given to the bladder. After surgery, it is necessary to insert a catheter into the bladder, to drain the urine, for about two to three days, until it can be imposed against urine normally.
Although it is a relatively simple operation, there may be several complications, such as:
Urine infection – 5-10% of patients will suffer from a urine infection. Typical signs of infection are turbid and smelly urine, feeling cold, tremors, heat, sweating, and general bad feeling.
Bleeding that lasts for several days will appear in about 5% of patients. If the bleeding does not stop, it is necessary to re-burn the bleeding area in the bladder. This operation is performed under anesthesia.
A hole in the bladder will form in about 5% of patients. In most patients, the hole will heal on its own after about 10 days. In about 50-70% of cases, the tumor will return after surgery, so regular cystoscopy examinations are necessary, once every three months, for follow-up purposes.
Intravesical (intravascular) chemotherapy
Intravesical chemotherapy is administered directly into the bladder, using a catheter. This treatment allows direct contact of the drug with the cancer cells in the bladder wall. The most commonly used drugs in this treatment are mitomycin c, epirubicin, and synergy technology (details below). The advantage of the treatment lies in the scarcity of side effects, due to local administration.
The treatment is given on a one-time basis immediately after turbt surgery, or in a weekly treatment cycle for about six weeks. About 1% of patients will have a rash on their skin that will require discontinuation of treatment.
Chemotherapy for invasive bladder cancer
Chemotherapy is usually given through transfusion, but there is also oral administration. In most cases, a mixture of 3 to 5 chemotherapy drugs is used at the same time, to improve the chances of success of the treatment. When the cancerous tumor has spread to the bladder muscle or other body parts, chemotherapy will be administered intravenously. Treatment takes several days. It is carried out once every few weeks, for several months.