Therapy
The therapy of a bladder cancer depends on which variant of the bladder cancer it is. In the case of superficial bladder cancer, doctors remove it surgically by means of an operation abbreviated as ‘TUR’. This stands for ‘transurethral resection’.
This refers to a surgical removal of the carcinoma, in which the surgeon inserts the necessary instruments via (lat. : trans) the urethra (lat. : urethra).
In this way, for example, a current-carrying loop is inserted into the bladder, with which the pathological neoplasms are removed layer by layer. This type of procedure requires only a short hospital stay of a few days and is associated with considerably fewer risks than an operation in which the abdominal cavity is opened. This type of surgery used to be more common and involved not inconsiderable risks such as internal bleeding (when blood vessels are damaged) or injury to internal organs such as the kidneys.
In case of superficial bladder carcinomas, after a successful TUR there is also the possibility of the so-called instillation therapy, which is a type of chemotherapy. In this therapy, so-called cytostatic drugs are introduced into the bladder through a catheter, where they act for about 30 minutes. Cytostatics are drugs from chemotherapy that attack and kill cancer cells, but unfortunately have sometimes severe side effects.
Since in instillation therapy, however, the chemotherapeutic substances only act in the bladder, the otherwise serious side effects such as severe exhaustion, fatigue, hair loss, diarrhea, vomiting, etc. are eliminated. After the procedure, they are simply excreted again when you urinate.
Furthermore, there is the possibility of connecting a so-called immunotherapy. In this therapy, bacteria of the so-called vaccine group BCG (Bacille Calmette-Guérin) are introduced into the bladder. These are attenuated tuberculosis pathogens that cause an inflammatory reaction in the bladder, which kills the tumor cells.
This subsequent additional treatment aims to prevent a so-called relapse (a recurrence of the same disease). Its successes are considerable: after successful surgery and three months of follow-up treatment, two thirds of patients are cured. If the bladder cancer has reached an advanced stage or an infiltrating bladder carcinoma is present, such as when the muscle layer of the bladder is also already affected, healing of the affected person can usually only be achieved by a complete removal of the bladder (so-called cystectomy) under general anesthesia.
In the course of this procedure, the prostate and seminal vesicles are also removed in men, and the uterus, ovaries and surrounding lymph nodes in women. This leads to infertility in both men and women. Since such an operation can possibly lead to inflammation and infection in the wound area but also in the abdominal cavity, the risks of such an operation must be carefully weighed up, especially in older patients who are weakened by severe previous illnesses.
In fact, this operation is of such a considerable extent and severity that the mortality rate is 2-3% even today when performed optimally. If an operation seems too risky, there is also the possibility of chemotherapy. However, statistically speaking, chemotherapy unfortunately offers much lower chances of recovery.
If the bladder is removed completely, the urine must of course be given a new form of drainage afterwards. There are two possibilities here: The internal (so-called continents) and the external (so-called incontinents) urinary diversion. In the case of the internal drainage, a new bladder is formed from a piece of intestine, which is sewn to the urethra.In the case of external urinary diversion, the patient is given an artificial urine outlet (artificial bladder) through which the urine flows into a bag adhering to the abdomen, which must be emptied or changed regularly.
