Treatment of Stage III Bladder Cancer
Stage III bladder cancer is usually treated with radical cystectomy, with or without removal of nearby lymph nodes.
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Radical cystectomy - Cystectomy is used to remove the diseased area by cutting through the bladder wall. In radical cystectomy, the surgeon removes the bladder and tissue around the bladder as well as any lymph nodes (small, bean-shaped collections of immune system cells that help fight infections) and nearby organs that contain cancer. For men, the prostate may also be taken out. For women, the surgeon might also remove the uterus (womb), ovaries, and a small portion of the vagina and fallopian tubes (which connect the ovaries and uterus).
Following radical cystectomy, you will require urinary diversion.
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Urinary diversion - Urinary diversion allows your body to store and remove urine without a bladder. Your surgeon may use a piece of your small intestine to create a new tube through which urine can pass. The surgeon attaches one end of the tube to the ureters and the other end to a new opening, called a stoma, in the wall of the abdomen. You then use a catheter (a thin, flexible tube) to drain the urine. The operation to create the stoma is called a urostomy or ostomy.
In another type of reconstructive surgery, the doctor uses part of the small intestine to make a storage pouch (called a continent reservoir) inside the body. Urine collects in the pouch instead of going into a bag. The surgeon connects the pouch to the urethra or a stoma. If the surgeon is able to connect the pouch to the urethra and create a “neobladder” (new bladder), you will be able to urinate normally.
In rare cases, Stage III bladder cancer can be treated with partial cystectomy.
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Partial or segmental cystectomy - The surgeon removes only the cancer and part of the bladder. Because only a part of the bladder is removed, you can urinate normally after recovering from this surgery.
Depending on your cancer and your overall health, it might be possible to spare your bladder with transurethral resection (TUR), followed by chemotherapy and radiation therapy, instead of radical cystectomy.
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Transurethral resection (TUR), also known as transurethral resection of the bladder tumor (TURBT) - The urologist places a rigid cystoscope (thin lighted tube) called a resectoscope into the bladder through the urethra while you are under regional or general anesthetic. The resectoscope lets the urologist see into the bladder and remove the tumor using a wire loop at the end of the resectoscope. The surgeon can also burn the tumor off using a laser or high-energy electricity (fulguration).
Your doctor may consider giving you chemotherapy either before surgery (neoadjuvant) to shrink the tumor or after surgery (adjuvant) to lower the chance the cancer will come back in a different part of the body.
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Systemic (whole-body) chemotherapy - Anticancer drugs are injected into a vein or given by mouth. These medicines travel through the bloodstream to all parts of the body. Unlike intravesical or local chemotherapy, systemic chemotherapy can attack cancer cells that have already spread beyond the bladder to lymph nodes (small, bean-shaped collections of immune system cells that help fight infections) and other organs. These drugs kill cancer cells but can also damage some normal cells. This damage to normal cells can cause side effects.
The drugs used most often for systemic chemotherapy for Stage III bladder cancer are:
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Adriamycin® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. It stops the growth of cancer cells, causing them to die. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer you have.
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Platinol® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops the growth of cancer cells, causing them to die. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.
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Rheumatrex® or Trexall™ (methotrexate) - Methotrexate belongs to a group of chemotherapy drugs known as antimetabolites. It prevents cells from making DNA and RNA, which stops the growth of cancer cells. Methotrexate is given as a pill by mouth, an injection in a vein for up to 20 minutes, or an injection into a muscle. The dose depends on your size, the type of cancer you have, and how well your kidneys work.
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Velban® (vinblastine) - Vinblastine belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. It stops cell division, resulting in cell death. Vinblastine is given by an injection in a vein over 5 to 10 minutes. The dose and how often you get the medicine depends on your weight, your blood counts, how well your liver works, and the type of cancer you have.
Combinations of chemotherapy drugs are often more effective than individual drugs in treating bladder cancer. The combinations used most often for Stage III bladder cancer are:
- M-VAC (methotrexate, vinblastine, doxorubicin [Adriamycin], and cisplatin)
- MCV (methotrexate, cisplatin, and vinblastine)
- GenCIS (gemcitabine and cisplatin)
Your doctor might also recommend external beam radiation therapy (EBRT) if you cannot undergo radical cystectomy because you have other serious medical conditions. Sometimes EBRT is given in combination with internal radiation therapy.
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External beam radiation therapy (EBRT) - EBRT focuses radiation from outside the body on the cancer. Most people are treated with EBRT 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation.
This content has been reviewed and approved by Myo Thant, MD.
This content was last modified on
May 02, 2007
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