Bladder cancer - European Society for Medical Oncology

WHAT ARE THE TREATMENT OPTIONS?
Planning of the treatment involves a team of professionals from different medical
disciplines. It usually implies a meeting of the different specialists, called
multidisciplinary meeting* or tumor board review*. In this meeting, the
treatment planning will be discussed according to the relevant information
mentioned above.
The treatment will usually combine therapies that
• Act on the cancer locally, such as surgery, radiotherapy*, local chemotherapy* and local
immunotherapy*
• Act on the cancer cells all over the body using systemic chemotherapy
The exact treatment will depend on the stage of the cancer, on the characteristics of the tumor and
on the risks for the patient.
The treatments listed below have their benefits, their risks and their contraindications*. It is
recommended that patients ask their doctors about the expected benefits and risks of every
treatment in order to be informed about the consequences of the treatment. For some treatments,
several possibilities are available. The choice should be discussed according to the balance between
benefits and risks.
Treatment plan for non‐muscle invasive disease (stage 0a, stage 0is, stage I)
At these stages, the tumor is confined to the superficial layer of the bladder wall (mucosa*) and does
not invade the muscle of the bladder. The main goal of the treatment is to remove the local tumor by
surgery during a TURB*. However, additional treatment delivered locally in the bladder (called
adjuvant* intravesical* treatment) is recommended since it lowers the risk that the tumor recurs or
progresses.
The type of adjuvant therapy depends on the risk of progression* and recurrence*: for each patient
with a stage 0a or stage I tumor, this is calculated using a scoring system based on several tumor‐
specific characteristics.
Cystoscopy* and transurethral resection of the bladder tumor (TURB)*
After an initial cystoscopy all patients undergo a TURB. Often, the complete tumor is resected,
and the TURB in this case is the definitive treatment. However, sometimes, it is recommended to
give additional treatment (called adjuvant treatment*) with drugs that are applied directly into
the bladder (called intravesical* treatment). The type of additional treatment depends on the
individual risk of recurrence and progression*, but also the patient’s capability to tolerate side
effects*.
In selected patients with high risk tumors, a second TURB is recommended either before or after
intravesical therapy, to help detect residual disease and to provide a more accurate staging.
Bladder cancer: a guide for patients‐ Information based on ESMO Clinical Practice Guidelines ‐v.2012.1 Page 12
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