Bladder cancer treatment

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

Treatment of bladder cancer differs radically for superficial (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 to use significantly more aggressive surgical (radical cystectomy, resection), radiation and chemotherapeutic methods of treating bladder cancer.

In biological terms, this division is conditional, since stage T tumors can also be considered invasive (invasion of the basement membrane), they are very often highly aggressive due to their poorly differentiated structure, superficial CIS always has a poorly differentiated structure, can occur both independently and in combination with the main tumor and often requires radical cystectomy.

The arsenal of treatment measures for bladder cancer includes surgical methods (radical cystectomy, wall resection), radiation therapy and chemotherapy.

Although radical cystectomy is the generally accepted "gold" standard in the treatment of bladder cancer, due to its large volume, it is preferable to perform it on relatively young patients without severe concomitant diseases. More than half of patients with the invasive variant have contraindications to surgery, so other methods of treating bladder cancer are more preferable for them.

The table shows that TUR is the most important stage of bladder cancer diagnostics in all forms and stages of the disease and the main method of treating its superficial tumors. The method of choice in the treatment of bladder cancer is radical cystectomy, but according to special indications or if it is impossible to perform it, wall resection is performed, systemic chemotherapy and radiation therapy are carried out.

Treatment tactics for patients depending on the stage of the disease and the degree of differentiation of transitional cell carcinoma of the bladder

Stage of the disease	Degree of tumor differentiation	Treatment methods
T0	Benign structure (urothelial papilloma)	TOUR
	PUNLMP	TOUR
	Well differentiated cancer	TUR and single intravesical instillation of chemotherapeutic drug
	Poorly differentiated cancer	TUR and single intravesical instillation of chemotherapeutic drug
CIS	Poorly differentiated	TUR and intravesical immunotherapy)
T1	Poorly differentiated	TUR and intravesical chemo- or immunotherapy, cystectomy
T2-T4	Poorly differentiated	Diagnostic TUR of the bladder Radical cystectomy For narrow indications: resection of the bladder cancer wall, radiation therapy, systemic chemotherapy
	At M+	Adjuvant chemotherapy (M-VAC)
T1-T4N+M+	Poorly differentiated	Diagnostic TUR Systemic chemotherapy with cystectomy or radiotherapy

Non-drug treatment for bladder cancer

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

Radiation therapy is prescribed when the risk of radical cystectomy is unacceptably high (age, concomitant diseases), it is impossible to perform it (stage T4b), or the patient does not agree to the removal of the affected organ.

A prerequisite for this treatment of bladder cancer is normal capacity, absence of urinary tract infection, previous inflammatory processes or surgery on the pelvic organs. Radiation therapy can only be performed in specialized radiation therapy centers.

The main types of radiation therapy:

• remote irradiation;
• intra-tissue irradiation (brachytherapy).

The usual total radiation dose is 60-66 Gy, a single daily dose is 1.8-2.0 Gy. The course of treatment for bladder cancer should not exceed 6-7 weeks.

Intra-tissue brachytherapy is performed by implanting radioactive radiation sources (cesium, irridium, tantalum) into the tumor tissue. This treatment for bladder cancer is often combined with external irradiation and organ-preserving surgery.

Sometimes radiation therapy is combined with the use of radiosensitizers or chemotherapy, but the long-term results of such treatment are unknown. Radiation therapy can also be performed for palliative purposes to eliminate pain, hematuria, and urinary disorders).

Patients usually tolerate radiation well, but 15% of patients may develop serious complications: radiation damage (5%), rectal damage (5%), intestinal obstruction (3%). Impotence develops in 2/3 of men.