Bladder Cancer 

 How must be the ideal Treatment strategy in bladder tumor?
What are the innovations in bladder tumor?

Bladder cancer treatment varies from person to person. The most important issue is that the treatment must be directed by a Urooncologist. Bladder cancer treatment should be administered by a specialist with the highest level of training in Urologic oncology (the specialty of cancer treating bladder cancer) or minimally invasive procedures with an emphasis on urologic oncology. Also, your doctor should be skilled in reconstructive procedures to create functional new bladders after cystectomy (removal of the bladder) and for men who need urethral reconstruction (a procedure to fix the tube that carries urine out of the body).

Non-Muscle Invasive Bladder Cancer Treatment
Non-muscle invasive bladder cancer (superficial) is on the lining of the bladder and has not spread to muscle tissue.
Treatments:
* Transurethral resection of bladder tumor (TURM)
* Systemic and intravesical (intrabladder) immunotherapy
* Intravesical chemotherapy

Transurethral Resection of Bladder Tumor (TURM)
Surgeons can often remove cancers that are non-muscle invasive using the TURM procedure. It is used to both diagnose and treat bladder cancer. The blue light technique has been used in recent years and it has been observed that it can slightly increase the success in selected cases.

Systemic and Intravesical Immunotherapy
Immunotherapy is treatment that supports your immune system to kill cancer cells more effectively. Bacillis Calmette-Guerin (BCG) is a common intravesical immunotherapy for bladder cancer. You should have regular cystoscopy after BCG treatment. If bladder cancer is not responding to BCG therapy, you may benefit from systemic immunotherapy with systemic drugs such as pembrolizumab.

Intravesical chemotherapy
The most common chemotherapy drug used for intravesical chemotherapy is mitomycin C. Its side effects are minimal compared to other chemotherapy. This is because mitomycin C stays in the bladder and does not affect your whole body.

Muscle Invasive Bladder Cancer Treatment
Muscle-invasive bladder cancer has spread from the inner surface of the bladder to the muscle or beyond. Muscle invasive cancers tend to be more aggressive.
Muscle invasive bladder cancer treatments:
* Cystectomy (bladder removal)* Chemotherapy for bladder cancer
* Radiation for bladder cancer* Immunotherapy for bladder cancer

Cystectomy (Bladder Removal)
Procedures to remove part or all of the bladder and nearby affected organs include:
* Partial (Partial) cystectomy (removal of part of the bladder) Success rate is low
* Radical cystectomy with robotic or open technique (removal of the entire bladder, some lymph nodes, and part of the urethra, the tube through which urine exits your body)
* Making a new bladder (artificial bladder) from the intestine

Chemotherapy for Bladder Cancer
Chemotherapy for muscle-invasive cancer is systemic. You take chemo either as a pill or intravenously (injected into a vein or muscle). It enters the bloodstream and kills cancer cells that have spread to other parts of your body.You can receive chemotherapy before (neoadjuvant) or after (adjuvant) bladder cancer surgery. Chemotherapy can:* Shrinks tumor to facilitate removal* Reduces the risk of cancer returning (relapse)Studies show that neoadjuvant chemotherapy increases overall survival and improves outcomes.

Radiation for Bladder Cancer
Radiation therapy uses beams of radiation to kill cancer cells. Radiation therapy:* To shrink cancer* To treat cancer that has spread to the lymph nodes* More aggressive treatment as chemoradiation* Combined with TURM and chemotherapy to protect the bladder
Immunotherapy for Bladder CancerImmunotherapy may be an option to treat advanced and aggressive bladder cancers (metastatic bladder cancer). The results are very recent and it is recommended to consult a urooncologist.

Prof. Saadettin Eskicorapci, MD, FEBU,