What are the treatment options for bladder cancer?
The UCLA Bladder Cancer Program offers a variety of innovative treatment options to patients who have been diagnosed with bladder cancer, including standard, minimally invasive and robotic-assisted surgery, as well as clinical trials. Treatment plans are individualized to each patient’s cancer grade and stage as well as current state of health. Furthermore, bladder cancer treatment options vary depending on whether the cancer is non-muscle invasive bladder cancer (NMIBC) or muscle invasive bladder cancer (MIBC).
The UCLA Bladder Cancer Program providers are leaders in the field for the treatment of muscle invasive bladder cancer (MIBC), offering:
an integrated clinic with medical oncology to provide neoadjuvant chemotherapy or immunotherapy
a history of coordinating with medical oncologists, even for patients living out of the area
expertise in robot-assisted laparoscopic robotic surgery in bladder cancer surgery and urinary diversion
innovative urinary diversion options
a vast array of clinical trials for patients with metastatic recurrences that can provide durable long-term responses.
Treatment for Non-muscle Invasive Bladder Cancer (NMIBC)
Trans Urethral Resection of Bladder Tumor (TURBT) - Initial staging and treatment of bladder cancer is performed by TURBT to determine the depth with which the tumor has invaded the bladder wall. This may be the only initial treatment for early stage tumors.
Intravesical Drug Therapy (Chemotherapy, Immunotherapy and BCG Therapy) - A TURBT is often followed by intravesical drug therapy, in which medications are placed into the bladder through a urethral catheter, including Bacillus Calmette-Guerin (BCG treatment for bladder cancer), mitomycin C, and interferon-alpha.
Active Surveillance – For appropriately selected patients, a specific active surveillance protocol can be implemented that includes intervals of cystoscopy, urine samples and possibly other radiographic examinations.
Treatment for Muscle Invasive Bladder Cancer (MIBC)
Cystectomy (Bladder Removal) Surgery – radical and partial
Open Radical Cystectomy
Robotic Radical Cystectomy, which is the robotic-assisted, minimally invasive removal of the bladder, may be the optimal treatment for bladder cancer for aggressive or recurrent disease. The surgery typically includes removal of the surrounding pelvic lymph nodes. Often, the urinary diversion can also be completed robot-assisted laparoscopically.
Types of Surgical Reconstruction to Replace the Removed Bladder
Neobladder - UCLA is an innovator in the reconstruction of the urinary tract. In selected patients, a portion of the intestines is used to create a new bladder or neo-bladder. The ureters are joined to one end of the neo-bladder and the other end is connected to the remaining portion of the urethra. The new bladder is constructed in such a way that it will provide a reservoir to store urine and control urine flow.
Continent Diversion - If the urethra is involved with cancer, it will need to be removed and some patients may benefit from creating a continent diversion, where one end of the new bladder will be brought out to the side of the abdomen to create a stoma without the use of an appliance bag. A small catheter is then passed through the stoma to drain out the urine and empty the new bladder 4 to 6 times a day.
Ileal Conduit - Some patients are better served by creating a simpler ileal conduit. This is created using a shorter portion of intestine between the ureters to a stoma connected to the side of the abdomen. It acts as a funnel to drain urine from the kidneys to an appliance bag attached to the patient’s skin. It requires an ostomy bag, but is a shorter and simpler operation with the least chance of post-operative or long-term complications.
Radiation Preservation Therapy for Bladder Cancer uses preservation techniques that may require patients to have both chemotherapy and radiation therapy. Cases are discussed in a multidisciplinary fashion with radiation oncology, medical oncology and urology physicians to provide an integrated and comprehensive treatment plan for our patients.
Treatment for Upper Tract Low Grade Urothelial Cancers using Mitogel
Urothelial cancer is a cancer that develops in the lining of the urinary system. While most urothelial cancers appear in the bladder, upper tract urothelial cancers (UTUCs) develop in the lining of the kidney (renal pelvis) or the ureter (tube that connects the kidney to the bladder). UTUC can block the ureter or kidney, causing swelling, infections and impairment of kidney function in some patients. At UCLA we offer Jelmyto (mitomycin biogel), a non-surgical therapy approved by the U.S. Food and Drug Administration (FDA) for treatment of low-grade UTUC. Many of the initial studies for Jelmyto that led to the FDA approval were developed at UCLA.
Genetic Risk Assessment Program
The UCLA Genitourinary Cancer Genetic Risk Assessment Program focuses on investigation into the potential genetic causes of an individual’s urologic cancer. Up to 5-10% of cancers are related to a genetic predisposition. If you have been diagnosed with a urologic cancer, UCLA’s team has specific referral criteria to determine if you should pursue genetic risk assessment to evaluate for a genetic cause of cancer. For those at greatest risk, often this knowledge can more precisely tailor a treatment plan that is optimal for you.
Support After Surgery
Radical cystectomy is a major surgical procedure and often patients with bladder cancer are in an age group with other medical problems. At UCLA, we have an excellent support structure to help patients before, during, and after your surgery. In addition to our surgical team, an internal medicine hospitalist service routinely follows all our bladder cancer patients following surgery and is available to see patients before surgery to get acquainted with some of our more complicated cases. We have well-trained nurses on the ward and intensive care unit, a pain service team headed by anesthesiologists, stoma nurses, social workers, physical therapists, and nutritionists. There are additional support services available through the UCLA Jonsson Comprehensive Cancer Center, https://cancer.ucla.edu/patient-care/supportive-care, as well as the Simms/Mann-UCLA Center for Integrative Oncology.