Bladder cancer is a significant health concern that affects thousands of individuals every year. Early detection and effective treatment are crucial for improving patient outcomes and survival rates.

This guide provides an in-depth overview of the latest treatments for bladder cancer, offering patients and their families valuable insights into the most current medical advancements.

Diagnostic tests for bladder cancer

Before diving into the treatment options, it is essential to understand the diagnostic procedures that help identify bladder cancer.

Urine tests

Urine tests are a common initial diagnostic tool used to detect bladder cancer. One such test is urinary cytology, which examines urine samples for abnormal cells. 

However, this method is not always accurate. It can sometimes detect abnormal cells even when no cancer is present (a false-positive result), or it can fail to detect abnormal cells when cancer is present (a false-negative result).

Due to these limitations, urinary cytology is used selectively and often in conjunction with other diagnostic methods.

Imaging

Imaging techniques play a crucial role in diagnosing bladder cancer and determining its stage and grade.

Kidney Ultrasound (USScan KUB)

A kidney ultrasound, also known as USScan KUB, is a non-invasive procedure that uses ultrasound waves to create images of the kidneys, ureters, and bladder. This scan helps identify any abnormalities in these organs and can provide valuable information about the presence and extent of bladder cancer.

CT Scan

A CT scan, or computed tomography scan, involves taking a series of X-rays to create detailed images of the inside of the body. This procedure may involve an injection of contrast dye to enhance image quality and highlight abnormal areas. CT scans are particularly useful for detecting bladder cancer and assessing whether it has spread to other parts of the body.

Cystoscopy (Flexible or Rigid)

Cystoscopy is a vital diagnostic tool for bladder cancer. This procedure involves using a cystoscope, a thin tube with a camera and light at the end, to examine the inside of the bladder. There are two types of cystoscopy: flexible and rigid.

• Flexible cystoscopy is usually performed in an outpatient setting and involves applying a local anaesthetic gel to the urethra. This gel minimises any pain and acts as a lubricant to allow the free passage of the camera. The procedure typically takes about five minutes.
  
• Rigid cystoscopy is usually performed under general or spinal anaesthesia. This type of cystoscopy uses a straight, inflexible cystoscope and is often used for surgical procedures such as biopsies or tumour removal. The procedure may take longer than flexible cystoscopy and often requires a brief hospital stay.

Once all the diagnostic tests are completed, it should be possible to determine the grade and stage of the cancer, which is crucial for planning the appropriate treatment.

What is the latest treatment for bladder cancer?

1. Trans-Urethral Resection of Bladder Tumour (TURBT)

Trans-Urethral Resection of Bladder Tumour (TURBT) is a common surgical procedure used to treat bladder cancer. It is performed under general anaesthetic.

During the procedure, the surgeon uses an instrument called a resectoscope to locate visible tumours within the bladder and shaves them away from the bladder lining using a mild electrical current. The removed tumours are then sent to a laboratory for histopathological examination to determine their nature and extent.

Post-procedure care

After TURBT, a catheter is inserted into the bladder through the urethra to allow urine and any blood or debris to drain into a bag. This catheter helps manage bleeding and maintains bladder function. Once the bleeding has settled, typically within 24-48 hours, the catheter is removed, and the patient is usually discharged from the hospital.

2. Intravesical Chemotherapy (Mitomycin C®)

Intravesical chemotherapy involves administering chemotherapy drugs directly into the bladder. One commonly used drug is Mitomycin C®. This treatment is often given immediately after TURBT to reduce the risk of cancer recurrence. Mitomycin C® is delivered directly into the bladder, where it can target cancer cells effectively with minimal systemic side effects.

The procedure typically involves instilling the drug into the bladder via a catheter. The patient is advised to hold the medication in the bladder for about an hour before voiding. This method ensures that the drug comes into direct contact with the bladder lining, maximising its effectiveness against cancer cells.

3. Intravesical Immunotherapy (Bacillus Calmette-Guérin – BCG)

Intravesical immunotherapy, using Bacillus Calmette-Guérin (BCG), is a highly effective treatment for high-grade superficial bladder cancer.

BCG is a variant of the vaccine originally used to treat tuberculosis (TB). It stimulates the patient’s immune system to attack cancer cells in the bladder.

Treatment process

BCG treatment is typically administered as an ongoing outpatient course. The procedure involves inserting a catheter into the bladder to instil the BCG solution. The patient is then asked to retain the solution in the bladder for about two hours before voiding.

This process is usually repeated weekly for six weeks, followed by maintenance treatments over several months or years.

Regular surveillance cystoscopies are conducted alongside BCG treatment to monitor the bladder and ensure early detection of any recurrence or progression of cancer.

4. Treatments for Muscle-Invasive Bladder Cancer

Muscle-invasive bladder cancer is a more aggressive form of the disease that requires comprehensive treatment strategies. The latest treatments for muscle-invasive bladder cancer focus on combining surgery, chemotherapy, and immunotherapy to achieve the best possible outcomes.

Radical Cystectomy

Radical cystectomy involves the surgical removal of the entire bladder and surrounding tissues that may be affected by cancer, such as lymph nodes and parts of the urethra. In men, this may include the prostate, while in women, it might involve the removal of the uterus, ovaries, and part of the vagina.

Following the surgery, reconstructive techniques are used to create a new way for urine to exit the body, either through a urostomy or a neobladder.

Chemotherapy

Neoadjuvant chemotherapy, administered before surgery, can shrink tumours and increase the likelihood of complete removal during cystectomy.

Adjuvant chemotherapy, given after surgery, aims to eliminate any remaining cancer cells and reduce the risk of recurrence.

The combination of chemotherapy with surgery has been shown to improve survival rates in muscle-invasive bladder cancer patients.

Immunotherapy

Recent advancements in immunotherapy have introduced new treatment options for muscle-invasive bladder cancer.

Immune checkpoint inhibitors, such as pembrolizumab and atezolizumab, have demonstrated efficacy in treating advanced bladder cancer. These drugs work by blocking proteins that prevent the immune system from attacking cancer cells, thereby enhancing the body’s ability to fight the disease.

Help is out there

Bladder cancer treatment has seen significant advancements in recent years, providing patients with more effective and diverse options. The four latest treatments discussed in this guide offer hope and improved outcomes for those affected by this condition.

Early diagnosis and prompt treatment are crucial for the best possible prognosis. If you or a loved one is experiencing symptoms or has been diagnosed with bladder cancer, we encourage you to seek medical advice and discuss these treatment options with your healthcare provider.

For further consultation and appointments, please contact our urology clinic.