Bladder cancer - European Society for Medical Oncology

Intravesical* chemotherapy* or immunotherapy*
In order to reduce the risk of recurrence and progression*, all patients that have had a TURB* are
given one single intravesical instillation* with a chemotherapeutic* agent, immediately after
surgery. The drugs that are used are Mitomycin C*, epirubicin* or doxorubicin*.
For patients with a tumor at low risk of recurrence and progression, one single instillation
completes the treatment. For patients who are considered to have an intermediate or high risk of
tumor recurrence or progression, the first instillation should be followed by further intravesical
chemotherapy, or by intravesical immunotherapy with bacillus Calmette Guérin (BCG)* (see
further). Whether chemotherapy or immunotherapy is chosen depends on the individual risk
profile. Chemotherapy is usually given for up to 1 year. Immunotherapy is given for a minimum of
1 year.
Intravesical* immunotherapy* with bacillus Calmette‐Guérin (BCG)*
For patients with selected risk profiles, it is recommended to give intravesical treatment with
bacillus Calmette‐Guérin (BCG), a vaccine used to protect against tuberculosis*. The working
mechanism of intravesical BCG therapy is not exactly understood. It is thought that BCG induces
an immune reaction* that kills cancer cells. Treatment with BCG is therefore considered as
immunotherapy.
Usually, an initial 6‐week treatment regimen is given (called induction therapy), and this is
followed by so‐called maintenance therapy for a minimum of 1 year. Some maintenance regimens
last two years.
Cystectomy*
Cystectomy is recommended for patients with stage 0is and stage I tumors that do not respond to
adjuvant* intravesical* treatment.
Treatment plan for muscle invasive bladder cancer (stage II, stage III)
At these stages, the tumor has invaded the muscle layer of the bladder or has extended through the
bladder wall into the tissues surrounding the bladder. The treatment aims to surgically remove the
entire bladder as well as the lymph nodes* in the pelvis and the neighboring organs. Prior to surgery,
chemotherapy* is administered and aims to reduce tumor size, to attack tumor cells in metastases*
that are too small to be detected, and to reduce the risk that tumor cells will spread to other parts of
the body during surgery.
Radical cystectomy*
The standard treatment for muscle invasive bladder cancer includes
radical cystectomy. For male patients this involves the complete removal
of the bladder, all visible tumor tissue, but also the urethra*, prostate*,
seminal vesicles*, the lower parts of the ureters* and the lymph nodes*
in the pelvis. For female patients, radical cystectomy involves removal of
the bladder, all visible and resectable tumors, the entire urethra, the
lower part of the ureters, the adjacent vagina*, the uterus* and the
lymph nodes in the pelvis.
In certain patients, this procedure may be slightly modified in order to preserve certain structures.
Whether or not this is possible depends on the tumor spread and needs to be carefully evaluated
in each individual patient.
Bladder cancer: a guide for patients‐ Information based on ESMO Clinical Practice Guidelines ‐v.2012.1 Page 13
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