Bladder cancer medical therapy
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Steven C. Campbell, M.D., Ph.D.
Overview
Medical Therapy
Immunotherapy
- Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells.[1]
- Bacillus Calmette–Guérin (BCG)
- Immunotherapy by intravesicular delivery of Bacillus Calmette–Guérin (BCG) is often used to treat and prevent the recurrence of superficial tumors.[2]
- BCG is a vaccine against tuberculosis that is prepared from attenuated live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans. BCG immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be superior to standard chemotherapy.[3]
- The mechanism by which BCG prevents recurrence is unknown, but the presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.[4]
Chemotherapy
Intravesical chemotherapy or systemic chemotherapy may be used to treat bladder cancer.
During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter. Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG. Mitomycin (Mutamycin) is the drug most often used in intravesical chemotherapy. A dose of mitomycin is usually put into the bladder after surgery to remove the bladder tumour. Intravesical chemotherapy with mitomycin reduces the risk of bladder cancer recurring (coming back) in people with tumours that are only in the lining of the bladder and have not grown into the muscle layer of the bladder wall (called non-muscle-invasive bladder cancer).
During systemic chemotherapy, the drugs are given through a needle into a vein (intravenously) and circulate throughout the body. Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder (called locally advanced cancer) and bladder cancer that has spread to other parts of the body (called metastatic cancer). Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.
Radiation therapy
External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.
Some people with cancer that has grown into the muscle layer of the bladder wall (called muscle-invasive bladder cancer) will have a transurethral resection (TUR) to completely remove all the cancer that the surgeon can see. This surgery is followed by both radiation therapy and chemotherapy.
Radiation therapy may be the main treatment for people who can’t have surgery. It may also be given to relieve symptoms caused by advanced bladder cancer (called palliative radiation therapy).
References
- ↑ Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/treatment/?region=ab Accessed on October, 7 2015
- ↑ Alexandroff AB, Jackson AM, O'Donnell MA, James K (May 1999). "BCG immunotherapy of bladder cancer: 20 years on". Lancet. 353 (9165): 1689–94. doi:10.1016/S0140-6736(98)07422-4. PMID 10335805.
- ↑ Lamm, Donald L.; Blumenstein, Brent A.; Crawford, E. David; Montie, James E.; Scardino, Peter; Grossman, H. Barton; Stanisic, Thomas H.; Smith Jr, Joseph A.; Sullivan, Jerry; Sarosdy, Michael F.; Crissman, John D.; Coltman, Charles A. (1991). "A Randomized Trial of Intravesical Doxorubicin and Immunotherapy with Bacille Calmette–Guérin for Transitional-Cell Carcinoma of the Bladder". New England Journal of Medicine. 325 (17): 1205–9. doi:10.1056/NEJM199110243251703. PMC 1164610. PMID 1922207.
- ↑ Bacillus Calmette-Guerin (BCG) for Bladder Cancer