*Please note that these are general statements applying to Basingstoke practice. If you have questions or concerns about your specific diagnosis and treatment, you should talk to your specialist nurse.
Bladder cancer surgery
Hugh Mostafid specialises in bladder cancer surgery. He has pioneered worldwide the development of a drug delivery system. This allows the administration of local chemotherapy (mitomycin) into the bladder after telescopic removal of bladder cancer, which halves the likelihood of cancer recurrence.
Transurethral resection (TUR)
This is often used to treat superficial bladder cancer.
During TUR, the surgeon inserts a cystoscope — an instrument with a special lens and fibre-optic lighting system — into your bladder through your urethra. The cancer is removed with a small wire loop and any remaining cells are burned away with an electric current.
In some cases, a blue light is used to visualise the cancer and ensure it is completely removed. TUR itself causes few problems. The patient is likely to have some blood in their urine or pain when they urinate for a few days following the procedure. Because superficial bladder cancer commonly recurs, patients will need to see a urologist for a cystoscopic exam every three to six months.
This extensive operation may be used for invasive bladder cancer or for superficial cancer that affects a large portion of the bladder. It involves removing the entire bladder, as well as nearby lymph nodes and part of the urethra.
In men, the prostate gland, seminal vesicles — which produce some of the fluid in semen — and a portion of the vas deferens (a conduit for sperm) are also removed. For women, radical cystectomy usually means removing the ovaries, fallopian tubes and part of the vagina.
Radiotherapy is given by an oncologist. This therapy uses high-energy X-rays to destroy cancer cells and shrink tumours. It may also be used after an operation to treat any remaining cancer cells.
When surgical treatment isn’t an option, radiation may sometimes be used instead. In treating bladder cancer, radiation will be delivered from outside your body (external beam radiation).
External radiation is usually performed as an outpatient procedure, with treatments occurring five days a week for five to seven weeks. Patients may find that they become tired during radiation therapy, especially during the last weeks of treatment.
Radiation can also cause the skin to become red, tender and itchy. Women may also experience vaginal dryness, and men may have problems with impotence. Radiation may also cause bladder or bowel incontinence, impotence in men and irritation of the rectum, leading to diarrhoea. These side effects are usually temporary. In the meantime, the oncologist may be able to offer measures to make them more manageable.
This treatment uses drugs to destroy cancer cells. Urologists in conjunction with an oncologist may suggest having chemotherapy after an operation to eliminate any remaining traces of cancer, but increasingly patients may have it before a surgical procedure in an effort to spare the bladder.
In most cases, two or more drugs are used in combination. They sometimes may be inserted directly into your bladder through your urethra — a procedure known as intravesical therapy. This treatment is commonly used following TUR to help prevent a very superficial cancer from recurring. You are likely to have intravesical therapy once a week for several weeks.
This isn`t an option if cancer cells have penetrated deep into the bladder wall or spread to other organs. In that case, chemotherapy drugs are given intravenously so that they travel through your bloodstream to every part of your body (systemic chemotherapy). This treatment is given in several cycles, which gives your body a chance to recover between sessions.
Even so, the side effects of chemotherapy — hair loss, nausea, vomiting and fatigue — can be severe. They occur because chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow — as well as cancerous ones. Not everyone has these side effects, however, and there are now better ways to control them if you do.
Systemic chemotherapy may also reduce the number of white and red blood cells in your body, making you temporarily more prone to infections and bruising. In addition, some drugs used to treat bladder cancer may cause kidney damage.
To help prevent kidney problems, you may be given intravenous fluids during your treatment and advised to drink lots of fluids.
Biological therapy stimulates your body`s own immune system to fight cancer. It’s usually used after TUR to help prevent superficial bladder cancer from recurring. Bacillus Calmette-Guerin (BCG) is the most commonly used immune stimulant. It binds to your bladder, where it triggers a response that inhibits the formation and growth of tumours. BCG is administered using a small, flexible tube (catheter) for two hours once a week. Treatment may last six or more weeks.
During treatment with BCG, you may have some bladder irritation or blood in your urine and feel as if you have the flu. Your doctor may suggest a medication to help reduce some of these signs and symptoms.