What are the treatments for Bladder Cancer?
If the bladder cancer is at its early stage, which means the cancer tumour has not yet eroded the muscle of the bladder, the cystoscopy may be used to scrub off the cancer cells. The doctor can also consider filling the bladder directly with anti-cancer drugs, or using B.C.G. immunotherapy:
- Transurethral Removal of Bladder Tumour – TURBT
The doctor uses the cystoscopy to remove the bladder tumour inside the inner lining of the bladder, and uses a small amount of electricity to cauterize the wound to stop the bleedings. For a few days after the surgery, the patient may experience haematuria.
- Intravesical Chemotherapy
With a soft tube, the doctor inserts anti-cancer drugs into the inner lining of the bladder via the urethra. The drugs may cause the inner lining to inflame, thus making the patient feel pain or have urinary frequency.
- BCG Intravesicle Immunotherapy
The vaccine may cause reaction in the bladder, stimulating the immune system to reduce the number of cancer cells. The treatment is carried out in 6 weeks, with weekly instillation. During the treatment, the medical staff use a catheter to insert liquid vaccine directly into a bladder. There may appear some immediate side effects, namely heamaturia, coughing, fever, chills, vigor, nausea, urinary frequency, feeling pain on urinating and skin rash, etc., but these will disappear gradually.
- Cystectomy
Should cancer cells have eroded the bladder muscle, the doctor will consider removing parts of the bladder or the whole of it. It is then necessary to create a stoma at the patient's abdomen to let the urine pass through. Some patients may create an artificial bladder out of their intestines. At present, this operation can be performed in the form of minimal invasive surgery, replacing a big wound with a few small holes.
If it is decided that the whole bladder to be removed, the male patient has to have his prostate gland, part of the urethra and the lymphatic glands near the bladder removed. The female patient may have her uterus, cervix, the nearby lymphatic and part of the urethra removed.
- Radiation Therapy
It is to kill the cancer cells with high energy radiation. Should a patient be found out not suitable to undergo surgery, he/she may be recommended to have radiotherapy alone or both radiotherapy and chemotherapy at the same time to replace an operation as a radical treatment.
- Palliative treatment
If the cancer has spread widely, the priority is to reduce the signs and symptoms and to maintain the patient's quality of the life. The systemic chemotherapy or immunotherapy can soothe the signs and symptoms and improve the quality of life, and even improve the survival rates. Radiation therapy can also reduce urinary frequency and haematuria.
- Artificial Storing of Urine
After the removal of the bladder, the doctor will at once try to create a place for storing urine. Depending on the conditions of the patient, the following methods can be considered:
- Stoma
The commonest way is to create an artificial urinary outlet by cutting a part of the intestine and using one of its end to connect the two urethras and the other end protruding out of the abdomen wall. The outlet on the abdomen wall is called a stoma, where a waterproof plastic bag will be fixed with some special glue for collecting urine. The stoma will not form an obstacle to the patient's normal life, but will affect the patient's look.
- bladder reconstruction surgery
Another method is to make an artificial bladder by cutting a certain length of the intestine. The doctor then reshapes the intestine part into a ball shape bag. He then sews it to the top of the urethra. Thus a new bladder is created and connected to the ureter. The patient can urinate through the urethra as usual, without having to use urine bag.
As the nerves of the patient's bladder are no longer functioning, he/she may suffer a slight urinary incontinence, especially when he/she is sleeping. After the operation, the male patient may become impotent while the female patient may experience differently during sexual intercourse.
- Urinary Catheter Operation
This is similar to that of the stoma. A length of the patient's intestine is used to make a urine bag which is then placed inside the abdomen. It is connected to a small plastic catheter which passes through the stoma, thus allowing the urine to emit. Urine can be relieved four to five times daily. The patient has to emit the urine manually, but he will not have to carry a urine bag.