How is muscle-invasive bladder cancer treated?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Blood in urine and urgency are key signs, and further tests like cystoscopy and imaging led to the right diagnosis. Muscle-invasive means the cancer has grown into the deeper muscle layer of the bladder.

Treatment options for you in such cases can be :

Radical cystectomy: The bladder is removed, along with nearby lymph nodes. In women, the uterus, ovaries, and part of the vagina may also be removed if cancer is nearby. Radical cystectomy is the gold standard for muscle-invasive bladder cancer (T2-T4a, N0/N, M0). Indications include:

1. Confirmed muscle invasion on TURBT (transurethral resection of bladder tumor) and imaging.

2. High-risk non-muscle invasive BCG (Bacillus Calmette-Guérin)-unresponsive tumors.

3. Persistent or recurrent MIBC (muscle-invasive bladder cancer) after chemoradiation.

For the choice of urinary derivation, the following methods are used;

Urostomy: A small stoma (opening) on the abdomen. Urine drains into a bag that you empty regularly. Urostomy is preferred in most women. Indications are:

1. Elderly patients (more than 70 - 75 years, less fit for complex surgery).

2. Impaired renal or liver function.

3. Tumors involving the bladder neck or the urethra.

4. Prior pelvic radiation.

5. Patient preference.

Disadvantages of this method are:

1. The required external stoma bag.

2. Higher long-term risk of urethral strictures and parastomal hernia.

Orthotopic neobladder: A new bladder is made from part of your intestine. You will pee through your urethra, but you need to catheterize occasionally. Indications are:

1. Good renal function (creatinine level (Cr) Cr less than 1.5 - 2,0 mg/dL, glomerular filtration rate more than 60 mL/min).

2. Motivated patient.

3. No significant comorbidities.

Contraindications are:

1. Urethral tumor involvement (required urethrectomy).

2. Severe incontinence or poor pelvic function.

3. Locally advanced disease (T4 b, nodal metastases).

Recovery: The patient must stay in the hospital for five to ten days. It will take four to six weeks to fully heal. Physical therapy can help with core strength.

Alternative treatment options (Non-surgical or bladder preservation) include,

Trimodal therapy (TMT) - Bladder préservation for:

1. Tumors (T2-T3a), less than 1.9 inches, unifocal tumors, no hydronephrosis or extensive CIS (carcinoma in situ).

2. Patient unfit for or refusing cystectomy.

Chemotherapy alone (palliative or definitive):

1. Neoadjuvant chemo (preferred before cystectomy).

2. Metastatic setting: immunotherapy, chemo.

Immunotherapy and targeted therapy:

If PD-L1 (protein on cancer cells), high-risk post-cystectomy, and for Cisplatin (a chemotherapy drug) - ineligible metastatic muscle-invasive bladder cancer.

I hope this information helps you.

Feel free to ask further queries.

Thank you.