Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Chemotherapy, Immunotherapy, and Biological Therapy
Chemotherapy is the use of powerful drugs to kill cancer. In bladder cancer, chemotherapy may be given alone or with surgery or radiation therapy or both. It may be given before or after the other therapies. Chemotherapy can usually be given in the oncologist's office, but it may require a stay in the hospital
Stages Ta, T1, and CIS bladder cancer can be treated with intravesical chemotherapy. After removal of the tumor, one or more liquid drugs are introduced into the bladder via a thin, plastic tube called a catheter. The drugs remain in the bladder for several hours and are then drained out, commonly with urination. This treatment is typically repeated once a week for several weeks.
Cancer that has invaded deeply into the bladder, lymph nodes, or other organs requires systemic or intravenous chemotherapy. The cancer-fighting drugs are injected into the bloodstream via a vein. This way, the drugs get into almost every part of the body and, ideally, kill cancer cells wherever they are.
Chemotherapy is well known for its unpleasant side effects. The side effects depend on which drugs you receive and how the drugs are given.
The severity of side effects varies by person. For unknown reasons, some people tolerate chemotherapy much better than others.
Some of the most common side effects of systemic chemotherapy include nausea and vomiting, loss of appetite, hair loss, sores on the inside of the mouth or in the digestive tract, feeling tired or lacking energy (because of anemia, that is, low red blood cell count), increased susceptibility to infection (because of low white blood cell count), and easy bruising or bleeding (because of low platelet count). Numbness or tingling in the hands or feet can occur. Ask your oncologist about the specific effects you should expect.
These side effects are almost always temporary and go away when chemotherapy is over.
Multiple studies have demonstrated that intravesical chemotherapy is effective in decreasing the recurrence rate of superficial bladder cancers on a short-term basis.
Intravesical chemotherapy, such as Mitomycin, is often given as a single dose in the bladder immediately after the tumor has been removed with cystoscopy.
Intravesical chemotherapy can irritate the bladder or kidneys.
Intravesical chemotherapy is not effective against bladder cancer that has already penetrated into the muscular wall of the bladder or has spread to the lymph nodes or other organs.
Immunotherapy or Biological Therapy
Biological therapy takes advantage of the body's natural ability to fight cancer.
Your immune system forms substances in the blood that work against "invaders," such as abnormal cells (that is, cancer cells).
Sometimes, the immune system becomes overwhelmed by the very aggressive cancer cells.
Biological therapy, or immunotherapy, helps bolster the immune system in its fight against the cancer.
Biological therapy is typically given only in stages Ta, T1, and CIS bladder cancers.
One widely used immunotherapy or biological therapy in bladder cancer is intravesical BCG treatment.
A fluid containing BCG, an attenuated cow TB vaccine (altered Mycobacterium), is introduced into the bladder through a thin catheter that has been passed through the urethra.
The Mycobacterium in the fluid stimulates the immune system to produce cancer-fighting substances.
The solution is held in the bladder for a few hours and then can be safely urinated out. This treatment is repeated every week for 6 weeks and repeated at various times over several months or even longer in some cases. Researchers are still working to determine the best length of time for these treatments. Over time, the treatments may be required on a less frequent basis.
BCG may irritate the bladder and cause minor bleeding in the bladder. The bleeding is typically invisible in the urine. You may feel the need to urinate more often than usual or pain or burning when you urinate. Other side effects include nausea, low-grade fever, and chills. These are caused by stimulation of the immune system. These effects are almost always temporary.