How is bladder cancer treated?

Treatment will differ according to the spread of the cancer. There are two main groups.

Superficial cancer (non-invasive).

This means there is no evidence that the tumour has spread into the muscle coat of the bladder. The majority fall into this category and can usually be cured.

Treatment is usually by cautery (burning of abnormal tissue) through a cytoscope or scraping the tissue away with a specially adapted telescopic instrument. There may be only one, or possibly several, tumours on the bladder.

It is known that they can recur and the doctor will advise the patient to have regular checkup examinations by cytoscopy.

Anti-cancer drugs such as mitomycin C, or BCG (Bacillus Calmette-Guerin) are often used by installation into the bladder if it is confirmed that there is an increased risk of new cancers. If neglected, superficial cancer can progress to deep or invasive cancer.

Deep cancer (muscle invasive)

The cancer has grown deeper to involve the muscle lining of the bladder. This is more serious as there is a greater risk that the cancer may spread to the lymph nodes or other organs such as the liver or bone. Further tests like a CT scan or MRI scans will help to confirm that the cancer is confined to the bladder.

Treatment is usually a choice between radiation treatment or the total surgical removal of the bladder.

If the bladder has to be surgically removed, urine from the kidneys is diverted to the skin surface just below the waist line using a small portion of the small bowel (known an ileal loop diversion).

In this procedure, the tubes from the kidneys are joined to one end of a 12cm length of small bowel and the other end is brought out through the abdominal wall and onto the skin to form a stoma. A special adhesive bag is placed over the stoma to collect the urine. There is a tap on the bag to drain off the urine when necessary.

In certain circumstances, a more sophisticated form of diversion can be constructed. Bowel can be made into a pouch with a tunnel to the skin surface through which the patient passes a small tube to drain the urine.

Occasionally, a functioning bladder can be constructed from segments of bowel to form a continent bladder substitute, known as an orthotopic bladder substitute.

If the cancer has spread to the lymph nodes or other organs, treatment with medicines (chemotherapy) may be offered.