Bladder Cancer: Therapy Options

General measures

  • Nicotine restriction (refrain from tobacco use; smoking cessation reduces risk of recurrence and progression/risk of recurrence and progression)
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for the underweight.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.
    • Falling below the BMI lower limit (from the age of 19: 19; from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
  • Review of permanent medication due topossible effect on the existing disease.
  • Avoidance of environmental stress:
    • Occupational contact with carcinogens such as aromatic amines (such as aniline, benzidine, toluidine, 2-naphthylamine, naphthylamine, etc. and their derivatives; starting material for pharmaceuticals, plastics, pesticides or dyes).
    • Diesel exhaust (due topolycyclic hydrocarbons, PAHs; excretion of PAH metabolites via the kidneys).
    • Handling hair dyes

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination

Regular checkups

  • Regular follow-up examinations for early detection of recurrence (recurrence of disease). Follow-up appointments are risk-adapted [[guidelines: S3 guideline]]
  • Follow-up of non-muscle invasive bladder cancer [guidelines: S3 guideline]:
    • Low-risk NMIBC (non-muscle-invasive bladder cancer): patients with low-risk non-muscle-invasive bladder cancer should have cystoscopy (bladderoscopy) at 3 and 12 months after initial diagnosis and transurethral resection. If recurrence is free, the cystoscopy interval should be extended to once per year. If no recurrence is detected, urologic follow-up should be terminated after 5 years.
    • Intermediate-risk NMIBC: Patients with intermediate-risk non-muscle-invasive bladder cancer should receive cystoscopy every 3 months for the 1st year, every 6 months for the 2nd and 3rd years, and once a year starting at the 4th year.
    • High-risk NMIBC: Patients with high-risk non-muscle-invasive bladder carcinoma should receive cystoscopy every 3 months for the first 2 years, every 6 months for the 3rd and 4th years, and once a year starting at the 5th year.
  • Follow-up of muscle-invasive bladder carcinoma [guidelines: S3 guideline]: Follow-up intervals for detection of tumor recurrence by imaging should be performed in patients after radical cystectomy and urinary diversion depending on tumor stage. Locally confined bladder tumors (< pT2pN0cM0):
    • First follow-up after 3-6 months.
    • 1st to 2nd year of follow-up: 6-month intervals.
    • 3rd to 5th year of follow-up: 12-month intervals.
    • From 6th year of follow-up: If new hydronephrosis or positive urine cytology.

    Locally advanced bladder tumors (> pT3 and/or pN1):

    • First follow-up after 3-6 months
    • Until 3rd year of follow-up: 6-month intervals.
    • 4th to 5th year of follow-up: 12-month intervals.
    • From 6th year of follow-up: If new hydronephrosis or positive urine cytology.

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
    • Consume only limited energy-rich foods.
    • Moderate total fat intake
    • Little red meat (pork, beef, lamb, veal) and sausages.
    • Once or twice a week fresh sea fish, ie fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Refrain from contaminated foods such as offal and wild mushrooms
    • Do not eat moldy food
  • Observe the following special dietary recommendations:
    • The development of urinary bladder cancer is favored by frequent consumption of salted, smoked, and cured meat and fish. These foods contain carcinogens such as benzo(a)pyrene, nitrates and nitrites (as a component of curing salt). Their preparation produces compounds (nitrosamines) that are risk factors for urinary bladder cancer.
    • Diet rich in:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
    • In general, endurance training on a bicycle ergometer can be recommended, which is performed according to the principle of interval training. This means that load phases lasting 1 to 3 minutes alternate with rest phases also lasting 1 to 3 minutes. The training should be performed at about 80% of the maximum heart rate for a total of 30 minutes.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy