With the advent of the modern era, our lives have become much easier, but at the same time illnesses such as cancer are becoming more common. Bladder cancer is one of the most common types of cancer. Men are more likely to get bladder cancer than women. There is also an increased risk for the elderly, especially those between the ages of 75 and 84. It is crucial to understand that bladder cancer can affect both women and men regardless of their age.
What is bladder cancer?
The bladder is a hollow organ that stores urine before it can be released out of the body. Its muscle wall is expandable and can contract or relax to change its size. By contracting and relaxing, urine is released from the body.
Any changes or abnormal growth of cells present in the bladder can lead to bladder cancer. Cancer cells usually begin to grow in the inner layer of the bladder, the urinary or transitional epithelium. However, the tumour can grow out of the bladder and spread to the surrounding area. It can spread not only to the lymph nodes but also to other organs such as the lungs and liver (known as metastasis).
Hence, bladder cancer can occur in the inner linings (non-muscle invasive), in the muscle (muscle-invasive), in local areas (locally advanced), or could spread to other organs (metastatic).
Bladder cancer and recurrence
This type of cancer is infamous for its recurrence rate which is highest compared to other cancers. Although it is quite manageable if detected in the early stages, it is very likely that it will come back within a timeframe. In fact, it is said that about three-fourths of cancer patients relapse or die due to the recurrence of the disease within ten years after diagnosis. This is a shocking and very concerning matter for patients diagnosed with bladder cancer. So it is vital to avoid recurrence to increase RFS(recurrence-free survival) rate in the patients.
Several treatments are available to deal with bladder cancer like chemotherapy, immunotherapy, radiation, and surgery. The type of treatment depends upon the stage and grade of the tumour found in the diagnosis. Chemo or immunotherapy most often follows the removal of tumor. In chemotherapy, drugs kill the cancer cells while immunotherapy relies on BCG for boosting the immune system of your body to fight cancer cells.
In the case of low-risk NMIBC(non-muscle invasive bladder cancer) patients, as well as those at very low risk of recurrence. Ta LG/G1 (tumour stage) detected more than one year after TURB treatment, SI(single instillation) of chemotherapy can significantly reduce the recurrence rate of NMBIC compared with TURB treatment alone. Therefore, the combination of TURB and SI is a better choice for low-risk NMIBC patients.
Just a single instillation may not be enough to prevent a recurrence. Therefore, the instillation of other adjuvant chemotherapy drugs may perform the procedure. But neither of them had a significant impact on recurrence rates.
Repeated chemotherapy administration may induce RFS or disease-free survival in intermediate-risk patients. This can be done in the presence or absence of SI in the patient.
Immunotherapy after the surgery works can reduce the risk of recurrence. It uses immunotherapy drugs like BCG(Bacillus Calmette-Guerin). BCG is the same one in use for the tuberculosis vaccine. This treatment focuses on boosting our immune system so that it can fight cancer. It is usually recommended for carcinoma in situ or CIS. This treatment delays and minimizes the risk of progression of the tumor.
In fact, several analyses have shown that BCG after TURB works better than TURB or TURB plus chemotherapy. This combination appears to be a better approach to preventing the recurrence of NMIBC. The effects of this treatment are long-lasting for patients at average risk. It may also be helpful for high-risk NMIBC patients.
While some studies point out that chemotherapy plus radiation can reduce the recurrence at least by half. This combination works better than these treatments carried alone, especially for invasive bladder cancer.
As per the clinical trials, if the bladder is administered with the chemotherapy drug gemcitabine (Gemzar) after the removal of the cancerous mass or tumour after surgery, can reduce the chance of recurrence significantly. This trial was performed for the low-grade tumour which has a high rate of recurrence. They received single instillation or SI of this drug but had a reduced risk of recurrence for the next four years. Usually, the patients need to go through multiple treatments during their treatment. This is quite a simple, safe and effective approach to prevent a recurrence. TURBs are much more expensive.
Apart from gemcitabine, another drug called mitomycin C can also be a suitable candidate for carrying out chemotherapy and stopping the recurrence of bladder cancer. But if you compare these two drugs, gemcitabine is a better choice due to its cost-effectiveness and lesser side effects. It is much more tolerable than mitomycin C. on the other hand, mitomycin C can be toxic if it leaks out of the bladder. It can cause severe rashes if it comes in contact with the skin.
New clinical trials have opened up many ways to reduce the recurrence of bladder cancer. The type of approach can differ based on the type and grade of tumour which can be invasive or non-invasive. Recurrence is a burning issue for the patients who are on their way to recovery and affect their survival and quality of life severely. So, more research and trials are needed to find ways to combat this problem.