Maintenance Therapy for Bladder Cancer
- Maintenance therapy for bladder cancer looks similar for most patients, no matter what type of bladder cancer you have.
- However, it’s important to know what kind of bladder cancer you have before beginning maintenance therapy.
- Maintenance therapy for bladder cancer is extremely important, as the risk of recurrence is highest within the first two to three years, and especially within the first year.
The type of bladder cancer you have depends on the type of cell in which the cancer began to grow. There are four types:
- Urothelial carcinoma of the bladder most common bladder cancer that accounts for about 90% of cases
- Squamous cell carcinoma of the bladder second most common type of bladder cancer
- Adenocarcinoma of the bladder rare form of bladder cancer that accounts for about 1% of cases
- Small cell carcinoma of the bladder an aggressive form of the disease
- Non-invasive cancer is only in the inner lining layer of the bladder
- Non-muscle-invasive cancer found in the tissue that lines the inner surface of the bladder and has not spread into the muscle
- Muscle-invasive cancer that has spread into the detrusor muscle of the bladder
“Following your urologist’s recommendations on intravesical therapy, for example, with respect to induction and maintenance, is important to mitigate the risk of the cancer recurring and to mitigate the risk of needing to have the bladder removed down the road,” Dr. Tyson says.
Dr. Tyson gives us an example of a patient diagnosed with bladder cancer and what maintenance therapy typically looks like for them:
"BCG induction is where they (patients) receive one dose a week for six weeks that's getting the immune system primed for BCG exposures," he explains. (This is for patients with high-grade cancer.) Then the patient will undergo a surveillance cystoscopy, which is a procedure to look inside the bladder using a thin camera called a cystoscope. The camera is attached to a long tube that's inserted into the urethra, then into the bladder. (It should also be noted that surveillance is not the same as maintenance therapy; a cystoscopy is not a form of maintenance therapy.)
If there's no evidence of recurrence, Dr. Tyson says that your doctor will begin BCG maintenance therapy, which typically occurs once a week for two to three weeks. At the Mayo Clinic Arizona, where Dr. Tyson practices, doctors follow the Southwest Oncology Group, or SWOG, protocol for BCG maintenance. This is when BCG is given at three months, six months, 12 months, then every six months. Then a patient will get a cycle of three sequential, weekly doses of BCG. "It is intended to prevent the cancer from recurring," he says.
"If you think about it (BCG) as an immunotherapy which most of us do then repeated exposure over time is going to continue to allow the immune system to do the work that it does against the cancer locally in the bladder," Dr. Tyson says.
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