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Treatment of Bladder cancer by Stage
Treatment of bladder cancer depends on the clinical stage of the tumor when it is diagnosed for the first time. Aspects that are considered include if cancer has spread beyond the bladder and how deep it has grown into the bladder.
In addition, factors such as the overall health and preferences of an individual, how fast the cancer cells are growing and the size of the tumor also determine the type of treatment.
Treating Stage 0 Bladder Cancer
Stage 0 bladder cancer includes both flat non-invasive carcinoma and non-invasive papillary carcinoma. In stage 0 bladder cancer, the cancer is only present on the inner lining layer of the bladder and has not invaded the wall of the bladder.
Stage 0 bladder cancer is an early stage of bladder cancer. It is treated with transurethral resection with fulguration and intravesical therapy within 24 hours.
In some cases, there is no need for further treatment. Instead, cystoscopy is done every 3 to 6 months to be on the lookout for signs that cancer might recur. Low grade non-invasive papillary tumors, intravesical chemotherapy is done every week after once surgery is done.
If cancer recurs, there is a need for treatment to be repeated. Intravesical chemotherapy can be repeated for the next 1 year. Fast-growing or high-grade non-invasive papillary tumors are more likely to recur after treatment therefore intravesical BCG should be used after surgery.
TURBT should be repeated to ensure cancer does not affect the muscle layer. BCG is given every week for a couple of weeks. Some doctors prefer feel intravesical BCG to intravesical chemotherapy for treatment of high-grade cancer.
It is rare for stage 0 bladder cancer to require extensive surgery. In cases where there are many superficial cancers or when cancer continues to spread, partial or complete cystectomy is done.
Intravesical BCG is the preferred treatment for flat non-invasive tumors after TURBT. A few weeks after TURBT, BCG is started every week for 6 weeks.
Follow up and outlook after treatment
Close follow-up is needed for bladder cancer patients. Cystoscopy is one after every 3 months for a few years to look for any signs that there might be new tumors or cancer might be recurring.
The outlook for people with stage 0a bladder cancer is good. It is common to find superficial cancers in the bladder or other parts of the urinary system during long-term follow-up care. There is no need to treat these new cancers. These new cancers are rarely life-threatening.
However, the outlook for stage 0is is not good. These cancers usually come back and maybe more serious. They may return and grow into deeper layers of the bladder and spread to other tissues.
Treating Stage 1 Bladder Cancer
Stage 1 bladder cancers grow into the connective tissue of the wall of the bladder although they do not reach the muscle layer. The initial treatment given for these cancers is transurethral resection with fulguration.
TURBT is done to determine the extent of cancer. In case no other treatment is offered, a new bladder cancer that is more advanced will develop especially if the first cancer was high-grade.
A second TURBT is recommended even for low-grade bladder cancer. High-grade cancer usually has numerous tumors. Large tumors in high-grade cancer are treated using radical cystectomy.
Treating Stage 2 Bladder Cancer
Stage 2 bladder cancer invades the muscle layer of the wall of the bladder. The initial treatment given is TURBT which is done to determine the actual stage of cancer rather than trying to cure it.
Radical cystectomy is the recommended treatment for cancer that has invaded the muscle. If the cancer is only on one part of the bladder, partial cystectomy is done. Radical cystectomy is offered for people who are not well enough to get chemotherapy.
Most doctors recommend chemotherapy before surgery since it helps patients to live longer compared to when only surgery is done. Radiation is done for bladder cancer that has spread to nearby lymph nodes.
Immunotherapy drug is given for people who have undergone surgery but there is a high chance of the tumor coming back. Some people can have a second transurethral resection followed by radiation and chemotherapy.
This helps patients to keep their bladder. However, doctors do not agree with this approach since the outcomes are not so clear. When this treatment is used, there is a need for frequent follow-up exams.
Cystoscopy is recommended and biopsy is done during radiation and chemotherapy treatment. In case a biopsy sample shows that there is cancer still, a cystectomy is needed. Patients who cannot undergo surgery due to other health conditions have the option of radiation, chemotherapy, TURBT, or a combination the same.
Treating Stage 3 Bladder Cancer
Stage 3 cancer is spread outside the bladder and can grow into nearby tissues, organs, or even lymph nodes. At first, transurethral resection is done to establish how cancer has grown into the bladder. Thereafter, chemotherapy is done followed by radical cystectomy.
If chemotherapy is done before surgery, it helps shrink the tumor. Doctors prefer doing it this way because by shrinking the tumor, the surgery becomes easier.
Additionally, chemotherapy helps a person to live a longer life by killing any cancer that may have spread to other parts of the body. T4 tumors that spread beyond the bladder can be treated with chemotherapy.
Chemotherapy is done after surgery in some patients to kill cells that may have been left. Patients who receive chemotherapy after surgery remain cancer-free for a longer period.
Radiation is done after surgery if cancer is found to have spread to the nearby lymph nodes. Patients with single small tumors are treated with second transurethral resection followed by both radiation and chemotherapy.
Treating Stage 4 Bladder Cancer
Stage 4 cancer has reached the abdominal wall also known as the pelvic and may have spread to the lymph nodes and other parts of the body. It is difficult to get rid of stage 4 cancer. The first treatment would be chemotherapy if cancer has not spread to other parts of the body.
After chemotherapy, the doctor will recheck the tumor. In cases where the tumor is gone, doctors can do cystectomy or chemotherapy with or without radiation.
If the doctor rechecks and finds there are still signs of cancer in the bladder, it is recommended to do cystectomy or another type of chemotherapy or chemotherapy with or without radiation.
When bladder cancer has spread to distant parts of the body, chemotherapy is the first treatment option. After chemotherapy, the cancer is rechecked and if it is gone, a boost of radiation or cystectomy is done. If there are signs of cancer still, radiation or chemotherapy or both or immunotherapy is done.
Surgery does not always remove all cancer. The treatment aims to slow down the growth of cancer and stop it from spreading to allow patients to feel better and live longer. Before surgery is done, it is important to understand the goal.
There are three goals of the surgery. They are to help the patient live longer, to try to cure cancer or to relieve and prevent symptoms of cancer. Some people cannot tolerate chemotherapy due to health conditions. Such people are treated with immunotherapy drugs or radiation therapy.
Blockage of urine could severely damage the kidney thus urinary diversion is done without cystectomy to help relieve or prevent such blockages.
Treating Bladder Cancer that Recurs or Progresses
If cancer comes back after treatment or if it continues to grow during treatment, the treatment options will be determined by what treatments have already been used, the patient’s desire for treatment, the overall health of the patient, and where and how far cancer has spread.
Further treatment has various goals such as helping relieve symptoms, slowing down the spread of cancer, and curing cancer. It is important to consider the risks and benefits of further treatment.
However, if cancer recurs more than once, the bladder may need to be removed. Non-invasive tumors that keep spreading after being treated with BCG can be treated with immunotherapy with pembrolizumab.
Cancers that recur in different parts of the body are treated with radiation therapy, chemotherapy, targeted therapy, and immunotherapy since they are difficult to remove with surgery.
When standard treatments cannot control cancer, it is recommended that the patient takes part in a clinical trial for new treatments for bladder cancer if they wish to continue getting treatment.
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Treatment of bladder cancer depends on the stage of cancer. Bladder cancer that is diagnosed very early is easy to treat compared to bladder cancer at stage 4. Treatment options for bladder cancer include chemotherapy, immunotherapy, radiation therapy, and cystectomy. Treatments can be combined.
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