Diagnosis and treatments

Treatment for bladder cancer depends on the stage of the disease, the type of cancer, and the patient's age and overall health. Options include surgery, chemotherapy, radiation, and immunotherapy. In some cases, treatments are combined (e.g., surgery or radiation and chemotherapy, preoperative radiation).Immunotherapy uses your body's immune system to fight cancer cells. The Bacille Calmette-Guérin (BCG) vaccine (used to prevent tuberculosis or TB) has been shown to be effective for treating some non-muscle invasive bladder cancers. It's put directly into your bladder (intravesical BCG) using a catheter. Treatment is given at weekly intervals, usually for six weeks. See Related topics for more information.Clinical studies may have various endpoints such as tumor recurrence, tumor progression or patient survival. In clinical trials comparing transurethral resection plus and an intravesical agent versus transurethral resection alone, a significant reduction in tumor recurrences was noted in 4 of 5 BCG studies, 2 of 5 mitomycin studies, 2 of 4 doxorubicin studies, and 6 of 10 thiotepa studies; and a significant reduction in tumor progression was documented in 3 of 3 BCG studies, 0 of 2 mitomycin studies, 0 of 2 doxorubicin studies, and 0 of 3 thiotepa studies.8 Of these agents BCG is the only one shown to result in a survival advantage over transurethral resection alone. The above studies demonstrate why BCG is favored as the first-line intravesical agent. However, recent pharmacologic studies involving mitomycin suggest its efficacy can be substantially increased by completely draining the bladder prior to drug administration, minimizing urine production, alkalinization of urine, and increasing the drug concentration.9 Application of these types of pharmacologic principles may also improve the efficacy of doxorubicin and thiotepa.Patients at high risk for cancer recurrence may also receive bacillus Calmette-Guérin (BCG) therapy after surgery.1 This therapy is the standard treatment for superficial bladder cancer. BCG uses inactivated tuberculosis bacteria (which cannot cause tuberculosis) to produce an inflammatory response in the bladder; the inflammation controls tumor growth. The treatment is given once a week for six weeks. Afterward physicians usually examine patients with a cystoscope every few months to ensure that the bladder is healthy and tumor free.Metastatic bladder cancer is cancer that has metastasized, or spread, to other organs such as the lungs, liver, or bones. This type of cancer is most commonly treated with chemotherapy designed to shrink the tumors.