5 Medications for Patients With Bladder Cancer: Treatment, Types

5 common types of medication therapies to treat bladder cancer

1. BCG intravesical immunotherapy
   • Bacillus Calmette-Guerin (BCG) vaccination treatment is a sort of intravesical (administered directly into the bladder) immunotherapy that can be used to treat individuals with early-stage bladder cancer that is solely found in the bladder lining and has not spread to the bladder wall muscle.
   • It is frequently utilized during a transurethral resection of bladder tumor (TURBT) surgery to remove tumors from the bladder lining.
   • A catheter is used to administer BCG immunotherapy into the bladder via the urethra.
   • BCG is a kind of bacterium that attracts immune system cells and induces them to attack bladder cancer cells.
2. Intravesical chemotherapy
   • Intravesical chemotherapy is a form of drug that is administered directly into the patient’s bladder via the urethra using a catheter.
   • Chemotherapy employs potent drugs that target actively dividing cancer cells.
   • Intravesical chemotherapy is often used to treat individuals with early-stage bladder cancer that is solely found in the bladder lining.
   • This sort of chemotherapy is routinely administered in patients following TURBT surgery to help eliminate any cancer cells that remain in the bladder lining and prevent recurrence of cancer.
3. Systemic chemotherapy
   • Systemic chemotherapy is administered orally or through injection into a patient’s muscle or vein.
   • Systemic chemotherapy medications penetrate the bloodstream and have the potential to harm all cancer cells in the body and not only those in the bladder lining.
   • Systemic chemotherapy is often used to treat patients with advanced bladder cancer that has progressed into the bladder muscle, nearby organs or tissues, or other sections of the body.
   • The following four types of chemotherapy are used to treat individuals with advanced bladder cancer:
     1. Neoadjuvant chemotherapy (before surgery)
     2. Adjuvant chemotherapy (after surgery)
     3. Chemoradiation therapy (systemic chemotherapy combined with radiation therapy)
     4. Chemotherapy may be used alone as a single treatment option
4. Immunotherapy medicines for bladder cancer
   • Immunotherapy drugs are a possible therapeutic option for individuals with certain types of bladder cancer, including some advanced and metastatic bladder cancers.
   • These drugs work by altering the way a patient’s immune system functions, allowing the patient’s body to attack cancer cells more effectively.
   • Immunotherapy medicines that have been authorized for the treatment of specific types of bladder cancer include:
     • Nivolumab
     • Avelumab
     • Pembrolizumab
     • Atezolizumab
5. Targeted therapy medicines for bladder cancer
   • Cancer is caused by alterations that occur inside cells, and targeted treatments are drugs that target these specific changes.
   • They differ from normal chemotherapy. They are more specialized and, as a result, can function in a different, more concentrated manner, treating cancer and limiting harm to healthy cells.
   • The following targeted medicines have been authorized for the treatment of people with specific types of bladder cancer:
     • Erdafitinib
     • Enfortumab vedotin
     • Sacituzumab govitecan

5 other treatment options for bladder cancer

Most bladder cancer patients have superficial tumors. Treatment for these tumors is frequently and highly successful, with a good prognosis. The rest of the bladder malignancies spread deeply into the bladder wall and muscle. In these circumstances, there is a higher chance of metastasis into other organs.

Bladder cancers can be treated with a single therapy or a combination of therapies depending on their severity.

1. Surgery: Bladder cancers are treated surgically using a variety of techniques. In most cases, hospitalization and anesthesia are required. Four common surgical options for bladder cancer are:
   1. Transurethral resection:
      • The cystoscope is inserted into the bladder by the surgeon through the urethra.
      • Cancerous tissue can be physically removed or burnt away with an electric current called fulguration.
   2. Cystectomy: A surgery may be carried out to remove part or all of the bladder depending on the stage and grade of the tumor.
   3. Segmental cystectomy:
      • A tiny part of the bladder containing malignant tissue is removed.
      • When there is only one spot of cancer cells in the bladder, this technique is most successful.
   4. Radical cystectomy:
      • The bladder, lymph nodes around the bladder, and any other tissues with cancer cells are all removed.
      • When there are many locations of malignant cells in the bladder and metastases to other places, this surgery is frequently utilized.
      • A urostomy operation is performed when the bladder is removed. This is a surgical treatment that involves making another opening for urine to flow through.
      • A radical cystectomy often involves the removal of the uterus, ovaries, and a portion of the vagina.
      • In most cases, the prostate gland and seminal vesicles are removed during a radical cystectomy in males.
2. Radiation therapy:
   • High-energy rays are used in radiation treatment to destroy or shrink cancer cells.
   • Bladder cancer can be treated with internal or external radiation or both.
   • Internal radiation involves inserting a radiation implant into the bladder to have a direct effect on cancer cells.
   • External radiation makes use of equipment located outside the body to aim rays at a larger region.
   • Radiation therapy for bladder cancer may cause nausea, vomiting, diarrhea, and urinary pain, as well as impair sexual function in both men and women.
3. Chemotherapy:
   • Chemotherapy kills cancer cells by using anti-cancer medicines.
   • Intravesical chemotherapy refers to the administration of chemotherapy medications directly into the bladder.
   • It may be administered systemically to influence cancer cells throughout the body.
   • Hair loss, nausea, vomiting, bruises, and exhaustion are all possible adverse effects of chemotherapy medications used to treat bladder cancer.
   • Other potential adverse effects include mouth sores, an increased risk of infection, and renal damage.
4. Biological therapy:
   • Biological treatment combats cancer by utilizing the body’s immune system. 
   • In one type of this therapy, a solution containing the bacteria Bacillus Calmette-Guerin (BCG) is injected into the bladder, where it activates the immune system to attack cancer cells.
5. Clinical trials:
   • New medicines are being evaluated through clinical trials and research investigations. Photodynamic treatment, which uses light to destroy cancer cells, and the use of interferon as an anticancer drug are two examples.

What is bladder cancer?

Bladder cancer is characterized by uncontrolled aberrant development and multiplication of cells in the urinary bladder that have escaped the usual mechanisms that limit excessive cell proliferation.

• Bladder cancer can spread (metastasize) to other regions of the body, including the lungs, bones, and liver.
• Bladder cancer invariably begins in the bladder’s innermost layer (mucosa) and can spread to deeper layers as it progresses. Alternatively, it may remain restricted to the mucosa for an extended length.
• The most typical appearance is a shrub (papillary) although it can take the form of a nodule, an irregular solid growth, or a flat, hardly detectable thickening of the inner bladder wall.

5 types of bladder cancer

1. Urothelial carcinoma or transitional cell carcinoma (TCC):
   • Responsible for 90 percent of bladder cancer cases
   • Arises from urothelial cells of the urinary tract
2. Squamous cell carcinoma: Arise from the bladder lining.
3. Adenocarcinoma:
   • Arise from the glandular cells
   • Account for about one percent of all bladder malignancies
4. Small-cell carcinoma:
   • They are of the rare type
   • Account for less than one percent of all bladder cancers
   • It is a neuroendocrine epithelial tumor that is poorly differentiated
5. Sarcoma: Rare type that arises from the bladder’s muscular cells.

7 common symptoms of bladder cancer

1. Blood in the urine (first and most common symptom) of bladder cancer
2. Pain near or around the lower abdomen
3. Difficulty passing urine
4. Burning sensation and pain while urinating
5. Frequent urination
6. Swelling in the feet and ankles
7. Pain in the bone (if cancer has spread to bones)

7 possible causes and risk factors of bladder cancer

1. Cigarette smoking: Cigarette smoking is believed to be the cause of approximately half of all bladder malignancies. Smokers who have had a history of smoking for a long time are at a higher risk of developing bladder cancer.
2. Age: The likelihood of having bladder cancer rises with age. Bladder cancer affects about 90 percent of individuals older than 55 years.
3. Gender: Males are more prone than women to getting bladder cancer.
4. Family history: A close relative with a history of bladder cancer may enhance one’s chances of having the illness.
5. Exposure to harmful chemicals:
   • Toxic chemicals, such as arsenic, phenols, aniline dyes, and arylamines, have been linked to an increased risk of bladder cancer.
   • Bladder cancer is more common in those who work in the dyeing, rubber, aluminum, and leather sectors, as well as truck drivers and pesticide applicators.
6. Past cancer treatments: Bladder cancer is especially common in people who have had radiation or chemotherapy for some types of pelvic cancer.
7. Chronic infections: Long-term chronic infections and irritation caused by stones or foreign objects are other risk factors for bladder cancer.

Prognosis of patients with bladder cancer

• Individuals with bladder cancer have a long-term prognosis that is determined by the size of the tumor, lymph node involvement, and degree of metastasis (spreading) at the time of diagnosis.
• Sometimes superficial bladder cancers return locally in the bladder, at the initial site of diagnosis, or elsewhere in the bladder. These recurrent tumors are assessed and treated in the same manner as the primary malignancy.
• However, if the tumor continues to grow, a cystectomy will be necessary at some point.
• Tumors that return in distant areas, however, may necessitate further therapies, such as chemo or radiation therapy.