Treatment Options for Early Bladder Cancer

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Types, grades, and stages of bladder cancer are some crucial factors that greatly influence the kinds of treatment options to treat the disease. These factors usually also affect the prognosis and outlook of patient for survival. In general, an advanced cancer in the bladder is more difficult to treat than when it is diagnosed at early stage.

See also the previous posts about symptoms of bladder cancer and best foods that help fight cancer, before continuing!

Unfortunately, there are some or even many cases of bladder cancer that recur -- according to an article published on Mayo Clinic. Therefore, patients often undergo follow-up testing after the treatment for some years to significantly reduce the risk of cancer to come back or reoccur. What kinds of test you need to take and how often - the answer is closely associated with your treatment, cancer type, and other factors.

What are types of bladder cancer?

There are some types, and it is important for doctor to make a clearly diagnosis of the cancer type. Because as mentioned before the information of this type is very crucial to find and determine the best treatment to treat the disease!

Transitional cell type

It is also often called as ‘urothelial cancer’. It develops from the cells in the lining of bladder (urothelium) - we call these cells as transitional cells. They usually will be bunched together when the volume of bladder is not full (empty). 

And when the volume of bladder is full then they will be stretched out into a single layer, and this can create a contact between these cells and the unfriendly waste products (like chemicals in cigarette smoke) in the urine. Over time, this may cause cancer in bladder.

Cancers of transitional cell type can behave in some different ways, such as superficial (non muscle invasive) and invasive bladder cancer.

Superficial (non muscle invasive) bladder cancer

It is the early stage of transitional cell type. The cancer of superficial (also often called as papillary bladder cancer) appears as shaped like mushrooms and small growths -- according to an article published on the Cancer Research UK. 

Fortunately, these growths are easier to treat because they can be removed and most of them also usually will not come back. Furthermore, they typically have not grown and spread into the deeper layers of the wall of bladder - they are typically only in the lining.

But there are also some types of superficial bladder cancer that have higher chance of coming back after surgery. T1 (high grade) and CIS (carcinoma in situ) tumors are some superficial types that are more likely to come back.

1. T1 tumors! They are a kind of superficial cancer, but they can grow more quickly (high grade) than other superficial types. About 30-40 percent (30-40 out of 100 patients) experience recurrence T1 bladder cancer.
2. Carcinoma in situ (CIS)! It is also more likely to grow more quickly and it looks very abnormal. It is more likely to reoccur than other types of superficial cancer in the bladder.

For patients with TI or CIS cancers, doctors /specialist usually will suggest more treatment than usual in order to greatly reduce the risk of cancer to come back. If they do reoccur, the specialists need to make sure that they can be removed as early as possible!

Invasive type

As mentioned before, there is a chance for transitional cell bladder cancer to become invasive. When it becomes invasive, this means that it not only grows in the lining of bladder but also can grow into the muscle layer or even beyond!

Invasive type usually requires more intensive treatment, because it is more likely to spread to other parts of patient’s body. In TNM staging system, invasive type can be categorized into ‘T2’, ‘T3’, and ‘T4’. Read more detailed information about the description of ‘T’ letter in the TNM staging system in here!

Squamous cell cancer

As the name suggests, it is a cancer that develops from the squamous cells (they are flat cells that usually have function to make up the skin like, moist, tissues lining the organs of body). 

This type is pretty common in areas /countries where certain worm infection is widespread (particularly the worm infection such as schistosomiasis or bilharzias).

Adenocarcinoma type

It can be categorized into rare types of bladder cancer. It is a kind of cancer that occurs from the lining cells of the bladder (these cells of lining have function to produce mucus in the bladder). In the UK, this type affects about 1-2 out of 100 patients with bladder cancer.

The following are other rare types:

1. The cancer is not always derived from the bladder lining, there is also possible for the cancer that occurs from the muscle or other structural tissues of bladder. 
2. Sarcomas! It is a kind of bladder cancer that begins in the bladder lining.
3. Small cell cancer type! Patients with this type usually require different treatment approaches (particularly for the chemotherapy treatment).

Secondary type

The mentioned previous types are categorized into primary bladder cancer (it means that the cancer is derived from the cells of the bladder). 

But there are also many cases of cancer in the bladder that caused by the cancer from the other parts of the body (particularly the nearby organs such as cancers of ovary, womb, cervix, and prostate)! A cancer from other parts /organs of the body that spread and affect bladder is called ‘secondary type’.

How to diagnose bladder cancer?

Most people who experience symptoms or signs of the disease usually will see their family doctor. Then they will be asked about their general health. 

Sometimes doctor may need to take a urine sample, and it is used to get to know whether the signs could be because of a urine infection. For some of them who have bladder cancer, their urine may contain abnormal cells (cancer cells).

If doctor thinks that patient may have bladder cancer, then patient will be referred to a hospital to see specialists for further tests.

At the hospital, the specialists usually will begin by asking the symptoms and medical history of patient. Then they may also examine patient by feeling the area around bladder and abdomen (tummy). If necessary, patient may also be asked to take another internal examination. 

Analyzing the urine sample and symptoms that occur is often not enough to make a clearly diagnosis of bladder cancer. In many cases, several tests are required - and the following are some of these tests:

1. Imaging tests! There are some imaging tests, such as CT scan test, IVU (Intravenous Urogram - a kind of X-ray examination), and ultrasound scan test. As the name implies, the imaging tests can create more detailed picture of specific area of the body which then will help specialist to closely examine the structure of the urinary tract.
2. -Urine and blood tests! MCM5 and NMP22 tests are several common urine tests to diagnose a cancer in the bladder. Sometimes the specialists may also need to perform a blood test to analyze a hormone called HCG (human chorionic gonadotrophin). The elevated HCG level may signal a cancer in the bladder that has spread.
3. Biopsy! Biopsy itself means taking a sample tissue of bladder which then will be closely examined & analyzed under microscope. 
4. Cystoscopy! In general, this test is the most crucial test in diagnosing bladder cancer. During this test, a specialist will put a special thin tube (it contains fiber optic) inside the bladder of patient. This method allows a specialist to see and explore inside the bladder and urethra of patient. Patients may have cystoscopy test done under general or only local anaesthetic - this depending each case of patient. With cystoscopy, removing a sample tissue (biopsy) also can be done.

In addition, sometimes these tests are also used to find the stage. And as mentioned before, it’s important to clearly diagnose the stage of cancer in order to determine the best treatment to cure the disease.

Treatment options for early bladder cancer?

Early cancer in the bladder is also familiar called as ‘non-muscle invasive or superficial bladder cancer’. In this category, the cells of cancer are still in the inner lining. In TNM staging system, early bladder cancer can be categorized into stage CIS (Tis), TA, and T1 -- according the Cancer Research UK.

So, what are treatment options when the cancer is still categorized into early stages? The following are pieces of helpful information!

Removing the tumor

For better prognosis and outlook of patient, it’s important to remove the cancerous tumor as soon as possible. In general, there are some kinds of surgery for removing cancerous tumor of early bladder cancer. Your specialist may recommend the following surgeries:

1. TUR (Transurethral resection)! The goal of this kind of surgery is to remove the cancer cells /cancerous tumors that are confined to the inner layers. During this surgery, the specialist will pass a small wire loop through a special device (called cystoscope) and into the patient’s bladder. With this loop, an appropriately electric current or high-energy of laser can be used to burn away the cells of cancer.
2. Segmental cystectomy! As the name implies, it is used to only remove specific portion of bladder that is affected by the cancer. It is usually an option if the cancer cells are limited to specific area of the bladder that can be easily removed without impairing /harming the function of bladder.

However, there is risk for patient to experience infection or bleeding during or after surgery. Therefore, it’s important for specialists to carefully concern about pros and cons of the surgery. Frequent urination problem is one of common side effects after surgery - this symptom usually occurs due to the decreased size of bladder after operation, but it may improve over time!

Chemotherapy

It is undeniable that chemotherapy is one of common treatment options for many kinds of cancer, including bladder cancer. To encourage the effectiveness of the treatment, it is usually given directly into the bladder. 

Chemotherapy into the bladder is a liquid, and doctor usually uses a catheter (a kind of flexible tube) to directly put the liquid of chemotherapy into the bladder. Patient should be careful when she/he pass urine for about 6 hours or more after the treatment, because the urine may still contain chemicals.

For instance, for men patients - they should sit down when they want to pass urine in order to decrease the chance of splashing. Patients should not get any urine on their hand, because some chemicals from chemotherapy in the urine may be able to irritate their hands.

This treatment can be used with other treatments. It may be used before and after surgery. It can help shrink the tumor before surgery. And for after surgery, it can reduce the risk of cancer to come back.

Fortunately, this kind of treatment usually causes fewer side effects than taking chemotherapy injections or tablets. Because giving liquid of chemotherapy into the bladder will allow the drug to be more likely to stay in the patient’s bladder and it usually will not get into the bloodstream.

If the side effects do occur, they may include; irritation of bladder and rash on feet /hands. Irritation of the bladder may cause cystitis (a kind of bad urine infection).

BCG (Bacillus Calmette-Guerin) into the bladder

BCG is not only one of common treatment options for early bladder cancer, but also helpful enough to greatly reduce the chance of cancer to grow back into the bladder. It is also helpful to stop the cancer to spread into the deeper layers. For more detailed information about BCG, read more in here!

Other treatment options

Studies and research are always going on to find the new methods of treatment that can be more successful to cure the disease. Experts are still looking for other options that can work better than BCG and chemotherapy.

1. Photodynamic therapy (PDT)! It uses an anti-cancer medicine that will work optimally when light shines on it. It is believed will stimulate more powerful immune body system to kill the tumor. Furthermore PDT is believed can directly destroy the cancer cells of bladder and may be effective to destroy any blood vessels that bring any nutrient or O2 for the tumor. Unfortunately, PDT is experimental at the moment. But the specialists may use it for the last option or when other treatments (particularly such as chemotherapy /BCG) have failed to treat the cancer.
2. IL2 and interferon! Like PDT, it is also the last option for the treatment of bladder cancer. Consult more with a doctor /specialist for in-depth information!

After the treatment - and what happens if the cancer reoccurs?!

After any treatment, now the specialist will concern to the chance of cancer to come back. Therefore, patients may still need to take some treatments (like regular cystoscopies) and have regular check-ups for some years - depending on the condition of each patient.

As mentioned before, not all types of superficial bladder cancer are always successful treated and will not come back! If you had T1 or T0, and after the treatment it comes back, then the procedure of cystoscopy is usually used again to remove a sample tissue (biopsy) which then will be closely examined to diagnose the stage of cancer. 

And the decision of the next treatments is usually dependent on the stage, grade, type, and other characteristics of new cancer that comes back.

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Reference: Articles published on MayoClinic and the Cancer Research UK