How is bladder cancer treated?

The treatment of bladder cancer depends on the location and how far it has spread. If it has not invaded the muscle or surrounding tissues yet (non-muscle invasive stage of bladder cancer or NMIBC) the tumour can be removed surgically via endoscopy through the urethra. This is called transurethral resection (TUR).

NMIBC has characteristically high recurrence rate. This means, that in up to 70% of all cases at some timepoint after surgery a new tumour develops in the bladder. To prevent this recurrence, the bladder is often flushed with a drug after TUR. This procedure is called intravesical instillation. The drug is instilled into the bladder with a catheter and can directly function at the mucous membrane, reducing the risk of new tumour development by killing remaining cancer cells or activating the immune system to fight those malignant cells.

If the cancer has already invaded deeper layers (muscle-invasive cancer), the bladder has to be removed completely. This is called radical cystectomy.

Intravesical immunotherapy

Bacillus Calmette-Guérin therapy: Bacillus Calmette-Guérin (BCG) is an effective intravesical immunotherapy for treatment of NMIBC. This living bacterium is derived from a bovine variant of the human tuberculosis pathogen.  Its virulence has been attenuated and the risk for treated patients to develop a serious infectious disease is very low.

For treatment of bladder cancer BCG is directly instilled into the bladder, where it triggers an immune response of the patient’s body. The alerted immune system can now detect the bladder cancer cells and attack them.
 

Intravesical chemotherapy

Chemotherapy drugs can be directly instilled into the bladder to kill actively growing cancer cells. For reatment of advanced states of bladder cancer, many of those drugs can also be given systemically via intravenous access.

A big advantage of giving the drug directly into the bladder instead of the bloodstream is the better tolerability. In the bladder the chemotherapy cannot reach other, more sensitive parts of the body and many of the notorious and dangerous side effects of systemic chemotherapy can be avoided. The most common side effect if intravesical chemotherapy is bladder irritation.