Bladder Preservation

Dr. Nimira Alimohamed, MD, FRCPC, Medical Oncologist

Duration: 4 minutes and 33 seconds

Muscle invasive bladder cancer is the stage of cancer where the tumor has grown into the muscle layer of the bladder wall. It’s more serious than earlier-stage cancers and can spread if not treated effectively.

Often, the standard treatment for this type of cancer is to remove the bladder through surgery, known as a cystectomy. This usually involves creating a new way for urine to leave the body, like through a bag outside the body or by making a new bladder from part of the intestine. This is a big surgery with a long recovery period and involves a huge adjustment period for patients. An alternative to removing the bladder is what we call “a bladder preservation approach” which uses a combination of treatments to try to get rid of the cancer while keeping the bladder intact. This is a good option for selected patients as there are some characteristics which make this approach more likely to be successful. These are patients who have a small, single tumor in the bladder and there is no evidence of hydronephrosis, which occurs when the tumor blocks off the ureter and the ureter and kidney can become dilated. If this is happening, patients are usually not good candidates for bladder preservation. Other things that make someone less of an ideal candidate for bladder preservation is that on the biopsy from the bladder, there is evidence of carcinoma in situ or lymphovascular invasion.

If a patient has a small tumor, they don't have any hydronephrosis, and they don't have any of these other features, then we would think about bladder preservation. However, if a patient does have one or more of these features, the success rate of bladder preservation is lower and this approach would not be recommended.

Bladder preservation means still treating the cancer aggressively while using a combination of radiation and chemotherapy (after the TURBT). Chemotherapy is medication that is given intravenously to kill cancer cell and radiation therapy uses high-energy rays are used to target and destroy cancer cells.

For example, a patient might be scheduled for six to eight weeks of radiation treatment and weekly chemotherapy at a low dose. This means that the patient comes to the cancer daily Monday-Friday to receive radiation therapy and on one day of each week, chemotherapy is also given. The chemotherapy portion is used to make the radiation work a little bit better. The purpose of this treatment is curative and to get rid of the cancer. During this time, the patient is being treated and monitored by a team including the urologist, medical oncologist and radiation oncologist. There are side effects which can be anticipated during and after treatment and the medical team will discuss those in detail prior to starting treatment.

In some patients, we may also recommend stronger chemotherapy before the combination chemotherapy / radiation plan. This usually involves up to 12 weeks of chemotherapy alone to target cancer cells which already be travelling throughout the body. Once patients finish this strong chemotherapy which is called neoadjuvant chemotherapy, then they proceed on to the combination part of the regimen.

After this initial treatment, doctors will monitor how well the treatment is working. Regular check-ups and tests are done to ensure the cancer hasn’t come back and that the bladder is functioning well.

This approach can be effective, but it doesn’t work for everyone. Success depends on the cancer’s response to treatment. Regular follow-ups are essential to catch any recurrence early and to manage any side effects.

In short, bladder preservation is about giving patients a chance to keep their bladder while still effectively treating their cancer. It’s a collaborative process between you and your medical team to determine the best course of action for your specific situation.

Presenter: Dr. Nimira Alimohamed, Oncologist, Calgary, AB

Local Practitioners: Oncologist