Bladder Cancer Chemotherapy, Immunotherapy and Radiation Therapy

Certain tumors require intravesical therapy in conjunction with transurethral resection. This is called "adjuvant therapy."

 

Intravesical therapy is a procedure where liquid medicine is inserted directly into the bladder with a catheter. Either a chemotherapy drug or immunotherapy medicine is used. This local administration of therapy reduces the side effects that are often present with traditional systemic chemotherapy. Systemic chemotherapy is administered intravenously (IV), or orally in pill form, and travels throughout the entire body killing cancer cells as well as healthy cells.

The goal of intravesical therapy is to prevent bladder tumors from growing or progressing. It is often used to eliminate carcinoma in situ or papillary tumors that cannot be surgically removed with transurethral resection. Intravesical therapy has also been successful in reducing the need for radical bladder surgery (cystectomy) in some patients.

Administration of intravesical therapy, when used as an adjuvant therapy to transurethral resection, begins two weeks after the TURBT procedure. A chemotherapy agent known as Mitomycin C is introduced into the bladder through a catheter. The medication remains in the bladder for up to two hours. This treatment is repeated once a week for six to eight weeks and may be continued less frequently for up to a year.

The chemotherapy drugs used in the intravesical treatments affect the cells inside the bladder but will not damage cells in other parts of the body. Because chemotherapy drugs can alter healthy cells while destroying cancer cells some side effects are associated with Mitomycin C. Side effects can include inflammation of the lining of the bladder which can result in painful urination, a frequent need to urinate, and blood in the urine.

Another agent often used in intravesical therapy is referred to as Bacille Calmette-Guerin, or BCG. BCG is an immunotherapy drug — a drug that consists of live, but weak bacteria effective in stimulating the immune system to kill cancer cells itself. Like intravesical chemotherapy, BCG is introduced through a catheter and retained in the bladder for up to two hours. BCG is recommended for high-risk tumors and not suggested for those who have already had a transurethral resection.

Another form of treatment for invasive bladder cancer is radiation therapy. Also known as radiotherapy, radiation therapy employs high-energy x-rays to kill cancer cells. The treatment is local and kills only the cells within a determined area. Radiation therapy may be given five days a week for up to seven weeks.

 

Radiation therapy may have side effects including nausea, vomiting, diarrhea or fatigue. It can also cause cystitis or inflammation of the bladder, which may lead to urgent and frequent painful urination. In some cases, the advantages of radiation therapy may outweigh the side effects. Radiation may preclude the need for radical cystectomy — the removal of the entire bladder — allowing the bladder to be preserved.

 

 

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