With the advent of technological changes and global connectivity, a lot has changed in our fast-paced life. Our life has become a hell lot easier but at the same time, diseases like cancer are becoming more and more common. Here we will discuss non-muscle invasive bladder cancer which is a subclass of bladder cancer.
We know that bladder cancer is quite common, one of the most common cancers. Men are more likely to be affected by bladder cancer compared to women. The risk is also higher for elderly people, especially in the age group of 75 to 84.
The bladder is a hollow organ that stores urine before it can be disposed of. Its muscle wall is stretchable and can contract or relax to change its size. Through contraction and relaxation, urine is released out of your body. When the cells present in the bladder undergo abnormal changes or growth, it can lead to bladder cancer. The cancerous cells usually start to grow in the inner lining of the bladder ie, urothelium or transitional epithelium. But the tumor can grow out of the bladder and go into the nearby areas. It can spread to lymph nodes and may even spread to other organs like lungs, liver, etc.
When cancerous cells are found in the lines of the inner surface of the bladder but the bladder muscle is unaffected, such type of cancer is Non-muscle invasive bladder cancer(NMIBC). There are various stages for NMIBC i.e., from Ta to T1.
More than half of low-grade Ta cancer patients experience tumor recurrence. About 6% reach higher levels. High-grade T1 cancer relapses at a rate of about 45%, 17% of which can progress late. Once diagnosed, the survival rate of NMIBC patients is very good. Survival rates for high-grade diseases range from about 70-85% in 10 years, and survival rates for low-grade diseases are much higher. However, it is important to detect the disease early. This helps doctors predict the course of the disease and choose the best treatment to stop its growth. Another thing to note is that this disease has a very high rate of recurrence which makes it harder for the patients to cope with.
Types of treatments currently available for NMBIC
Treatments available for bladder cancer are cystoscopic transurethral resection of the bladder (TURBT), Intravesical therapy, and surgery. If these treatment methods fail then one may have to opt for the removal of the bladder.
This kind of surgery is performed using a cystoscope insertion through the urethra. The cystoscope is straight, unbendable, and has a light at the end that allows the surgical instruments through it. You may be given general anesthesia. So, the surgeon can take out the tumor, or take samples. If the tumor has clear margins then the doctor can remove it completely.
In this type of treatment, drugs like Mitomycin C and gemcitabine are administered directly into your bladder with the help of a thin tube called a catheter. The drug stays in the bladder for a couple of hours before passing it out. This chemotherapy usually follows the surgery. The drugs kill the cancer cells directly in the bladder itself as compared to the bloodstream which is usually done for the other type of cancer. Hence, you can avoid the typical side effects of chemo like hair loss, etc. This treatment is usually recommended for NMIBC because the drugs reach the inner linings only.
In intravesical immunotherapy, immunotherapy drugs are used like BCG(Bacillus Calmette-Guerin). BCG is the same one used 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 has been shown to delay and minimize the risk of progression of the tumor.
Maintenance intravesical Therapy
After you get rid of the tumor, you may have to undergo maintenance therapy to prevent the tumor from coming back. It’s a good choice for people who had chemo or BCG treatment.
Surgery is usually performed to remove the bladder if intravesical therapy fails. It is also recommended if the chances of spreading are high and you can only rely on bladder removal.
We will discuss some of the guidelines that may be useful. In the case of NMBIC patients who have low risk, and also those who have a very low risk of recurrence of Ta LG/G1(stage of the tumor) detected more than a year later after having TURB treatment, single instillation(SI) of chemotherapy can significantly decrease the rate of recurrence of NMBIC as compared to TURB treatment alone. So the combination of TURB and SI is a better option for low-risk NMIBC patients.
Single instillation might not be sufficient to curb the recurrence alone. So, further adjuvant chemo instillations may be able to do the job. But they also do not impact the rate of recurrence very heavily.
Repeat instillations of chemo can RFS or recurrence-free survival in intermediate-risk patients. This can be done with or without the SI in the patients.
In fact, some analyses have shown that BCG after TURB has performed better as compared to any one of them carried alone or TURB plus chemo. This combination seems to be a better approach to preventing the recurrence of NMIBC. The effect of this treatment is long-lasting for intermediate-risk patients. It might be also helpful for high-risk NMIBC patients.
Even after years of research, the guidelines for best practices for NMIBC are yet to become standard. We have discussed some of the treatments and practices that can be helpful to combat this disease.