Bladder cancer medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

The predominant therapy for bladder cancer is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required.

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 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.

Chemotherapy

• Intravesical chemotherapy

• During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter.^[4][5]
• Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG.^[6]
• Mitomycin is the drug most often used in intravesical chemotherapy.^[7][8]

• Systemic chemotherapy

• During systemic chemotherapy, the drugs are given intravenously.
• Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder and bladder cancer that has spread to other parts of the body.^[9]
• 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.^[10]

Radiation therapy

• Radiation therapy may be the main treatment for people who can’t have surgery.^[11]

• External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.^[12]

• Palliative radiation therapy may be given to relieve symptoms caused by advanced bladder cancer.^[13]

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