Treatment of bladder cancer

Treatment of bladder cancer is only determined after the diagnosis is completed. They depend on the stage of the disease according to the TNM system, the degree of tumor differentiation, the size and number of tumors, the degree of danger of recurrence and the progression of the tumor.

The treatment of bladder cancer is radically different for surface (Ta, CIS, T1) and invasive (T2-T4) tumors of this localization.

This division is based, on the one hand, on the possibility of complete removal of superficial tumors by minimally invasive intervention (TUR) and, on the other hand, on the need for much more aggressive surgical procedures (radical cystectomy, resection), radiation and chemotherapeutic methods for the treatment of bladder cancer.

Biologically this division is arbitrary, since the tumors in stage T can also be considered invasive (invasion of the basal membrane), they are often highly aggressive due to the low-grade structure, surface CIS always has a low-grade structure, can occur both independently and in combination with the underlying tumor and often requires the implementation of radical cystectomy.

Arsenal of therapeutic measures in the treatment of bladder cancer includes surgical methods (radical cystectomy, resection of the wall), radiotherapy and chemotherapy.

Although radical cystectomy is a universally recognized "golden" standard in the treatment of bladder cancer, due to its large volume it is preferable to perform in relatively young patients without severe co-morbidities. More than half of patients with invasive variant have contraindications to the operation, therefore they prefer other methods of treatment of bladder cancer.

It can be seen from the table that TUR is the most important stage in the diagnosis of bladder cancer in all forms and stages of the disease and the main method for treating its superficial tumors. The method of choice in the treatment of bladder cancer is radical cystectomy, but under special indications or if it is impossible to perform it, the wall is resected, systemic chemotherapy and radiation therapy are performed.

Tactics of treatment of patients depending on the stage of the disease and the degree of differentiation of transitional cell cancer of the bladder

Stage of the disease	Degree of tumor differentiation	Methods of treatment
T0	Benign structure (urothelial papilloma)	TOUR
	PUNLMP	TOUR
	Highly differentiated cancer	TUR and single intravesical installation of a chemotherapeutic drug
	Low-grade cancer	TUR and single intravesical instillation of a chemotherapeutic drug
CIS	Low-differentiated	TUR and intravesical immunotherapy)
T1	Low-differentiated	TUR and intravesical chemotherapy or immunotherapy, cystectomy
T2-T4	Low-differentiated	Diagnostic TUR of the bladder Radical cystectomy Narrow indications: resection of the wall of bladder cancer, radiation therapy, systemic chemotherapy
	With M +	Adjuvant chemotherapy (M-VAC)
T1-T4N + M +	Low-differentiated	Diagnostic TUR Systemic chemotherapy with cystectomy or radiotherapy

Non-drug treatment of bladder cancer

Treatment of bladder cancer (stage T2, T3, T4)

Radiation therapy is prescribed at an unacceptably high risk of radical cystectomy (age, concomitant diseases), impossibility of its implementation (stage T4b) or disagreement of the patient to remove the affected organ.

A prerequisite for this treatment of bladder cancer is a normal capacity, no infection of the urinary tract, previous inflammatory processes, or surgery on the pelvic organs. Radiation therapy can be carried out exclusively in specialized centers of radiotherapy.

The main types of radiation therapy:

• remote irradiation;
• interstitial irradiation (brachytherapy).

The usual total dose of irradiation is 60-66 Gy, a single daily dose is 1, .8-2.0 Gy. The course of treatment of bladder cancer should not exceed 6-7 weeks.

Interstitial brachytherapy is carried out by implanting sources of radioactive radiation (cesium, iridium, tantalum) into the tumor tissue. This treatment of bladder cancer is often combined with remote irradiation and organ-preserving surgery.

Sometimes radiotherapy is combined with the use of radiosensitizers or with chemotherapy, but the remote results of such treatment are unknown. Radiation therapy can also be performed with a palliative purpose to eliminate pain, hematuria, urination disorders).

Irradiation patients are usually well tolerated, but in 15% of patients serious complications can develop: radiation damage (5%), rectum (5%), intestinal obstruction (3%). Impotence develops in 2/3 men.