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Treatment Options

Dr. Phillip Pierorazio points to a scan on a computer screen while talking with female patient.Phillip M. Pierorazio, M.D., discusses a scan with his patient.

At the Johns Hopkins Greenberg Bladder Cancer Institute, we emphasize patient education and encourage patient participation in the decision-making process.

Our multidisciplinary team assesses all the information — tumor stage/grade, pathology results, imaging and tumor genetic sequencing — and teaches patients about their diagnosis, and the risks and benefits of various treatment options. We then provide expert guidance to help patients arrive at care decisions that meet their specific needs.

Treating Nonmuscle-Invasive Bladder Cancer

Also known as nonmuscle-invasive bladder cancer, this type is considered “early stage” and represents about 70 to 75 percent of all bladder cancer cases. Nonmuscle-invasive bladder cancer means the cancer is found in the lining of the bladder and has not invaded the bladder’s muscle wall or spread outside the bladder.

While easier to treat, nonmuscle-invasive bladder cancer has a high rate of recurrence and a risk of progression that requires patients to undergo a lifetime of regular monitoring. This is a major reason why bladder cancer is the costliest cancer to treat.

Current Approaches

The Greenberg Institute currently offers several approaches to treating nonmuscle-invasive bladder cancer:

  • Cystoscopy using white light and enhanced blue light cystoscopy – Cystoscopy is the “gold standard” for examining the lower urinary tract and bladder lining. It is used to take photos and biopsies of cancerous lesions. During the cystoscopy, a thin, lighted tube with a camera is inserted through the urethra. For patients who have a bladder tumor identified via cystoscopy, we have the ability to use enhanced blue-light cystoscopy (cysview) to better identify and remove bladder tumors/cancers.
  • Transurethral resection of the bladder tumor (TURBT) – The tumor is removed using electrical force during a cystoscopy. This procedure is typically performed in the operating room.
  • Intravesical drug therapy – Chemotherapy or immunotherapy drugs are placed into the bladder via a catheter.

While the current standard of care calls for the use of white-light cystoscopy, research shows that blue-light cystoscopy — when used with a photosensitizing drug that is instilled in the bladder — improves tumor detection, which can lead to more accurate resection and lower recurrence rates.

The Greenberg Bladder Cancer Institute offers blue-light cystoscopy as a standard of care.

Learn more about treatment for nonmuscle-invasive bladder cancer in our health library.

Watch the webinar “Pathway to a Cure” with Trinity Bivalacqua, M.D., Ph.D., and Michael Johnson, M.D.

Watch an in-depth presentation of nonmuscle-invasive bladder cancer treatment options by Trinity Bivalacqua, M.D., Ph.D.

Treating Muscle-Invasive Bladder Cancer

Also called advanced bladder cancer, this type represents about 25 to 30 percent of all bladder cancer cases. Muscle-invasive bladder cancer is cancer that has invaded the bladder’s muscle wall. Some invasive bladder cancers have also metastasized, or spread, to surrounding organs or other parts of the body.

Current Approaches

The Greenberg Institute treats muscle-invasive bladder aggressively with curative intent through several patient-centered treatment approaches, including:

  • Radical cystectomy (bladder removal surgery) – Often, muscle-invasive bladder cancer requires complete surgical removal of the entire bladder. In a small portion of patients, it may be possible to remove just part of the bladder. Robotic-assisted laparoscopic radical cystectomy using a minimally invasive approach to bladder removal may also be an option for some patients.
  • Replacing the removed bladder – After radical cystectomy, the patient’s urinary function must be restored using one of several urinary diversion or bladder reconstruction procedures: ileal conduit, ileal orthotopic neobladder or continent catheterizable reservoirs (Indiana pouch).
  • Trimodal chemoradiation – This is an alternative approach to removal of the bladder, in which a thorough, complete TURBT is performed and then followed with systemic chemotherapy and radiation therapy to the bladder. This is used in selective patients with muscle-invasive bladder cancer that meets the criteria for bladder preservation.
  • Chemotherapy – Patients with good kidney function and adequate overall functional capacities are usually offered a combination of systemic chemotherapeutic drugs given prior to radical cystectomy. The chemotherapy is aimed at treating any microscopic spread of cancer that cannot be seen with traditional CT scan imaging, shrinking the known cancer within the bladder to optimize the curative potential of radical cystectomy. About half of patients meet the criteria necessary to undergo chemotherapy prior to surgery.

Learn more about treatment for muscle-invasive bladder cancer in our health library.

Learn what to expect before and after radical cystectomy at Johns Hopkins.

Trimodality Bladder Preservation for Muscle-Invasive Bladder Cancer

While radical cystectomy is often required to effectively treat muscle-invasive bladder cancer, a subset of patients can achieve good outcomes with a combination of tumor resection, chemotherapy and radiation. It’s not common for institutions to offer bladder preservation and do it well and often, but here at the Greenberg Bladder Cancer Institute, we do. 

Selection of patients best suited for trimodality bladder preservation is crucial. The expertise among the multimodality team of experts available at the institute allows a thorough individual evaluation of each patient to determine if trimodality bladder preservation can be offered as a therapy option.

Read more about bladder preservation therapy.

 
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