Published on May 18, 2021
Doctor Explains Treatment Options for Bladder Cancer
In this segment, Dr. Stephen Riggs, MD, Associate Professor in the Division of Urology at Levine Cancer Institute, explains some of the treatment options that are available depending on the status of your bladder cancer. Dr. Riggs differentiates between non-muscle-invasive and muscle-invasive bladder cancer and explains when a patient can be treated successfully with a standard of care regimen, or when a patient might be better served by a clinical trial.
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Transcript | What Are the Bladder Cancer Treatment Options?
What Are the Current Treatment Options for Bladder Cancer?
Dr. Riggs: So in terms of treatment options, if you just think of bladder cancer as a whole, about two-thirds of all bladder cancer that will walk in the door, everybody that gets it every year, is what's called non-muscle invasive. So, we think again of the disease in muscle invasion, into the muscle, right — to the right, I should say. And then non-muscle invasive to the left. If you're in non-muscle invasion, then you're really, your breakdown is: are you low grade or high grade? If you're low grade, we normally just scrape the tumor out because you've got to figure out how to get the tissue, the tumor. And so, the way we access the tumor in the bladder is we go through what's called the urethra. It is the water channel that you urinate through. For men, we go in through the water channel and I — we take what I call an ice cream scoop with electricity, or like a backhoe.
And we actually scoop out the tumor and we sample the soil below. So, think about it like a weed in a garden. You're going to take the weed out. You're going to sample the soil to determine if the roots go deeper. Once you understand where you are — low grade, high grade, non-muscle invasion versus muscle invasion — then really those treatment options sit in two buckets. If you are muscle invasive, okay, and let's say you're not stage four, you're not metastatic. Then you will either be offered your bladder removal, usually with chemotherapy before, in general, or you'll be offered chemo plus radiation as kind of a standard treatment, meaning they synergize, work together, chemo plus radiation.
If you're non-muscle invasive to the left, some of those folks, we are only scraping out the tumor if they're low grade. Or we're scraping out the tumor, if they're high grade, and using a combination of what's called intravesical treatment. That is treatment that goes into the bladder, vesicle bladder. And that is usually, there's a couple of them, but the main stake people will hear about is what's called BCG, the acronym BCG, and then to the far right, if you're metastatic. So, if you truly have disease outside the bladder, you're really talking about chemotherapy for most people as a start, or you're starting other, what we call systemic therapy, immunotherapy, or even clinical trials. And we're really talking about clinical trials in all those spaces. But what I've just outlined is kind of the basic standard treatment options.