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used in bladder cancers. Approximately half of patients
will achieve 5-year survival if they do not have metas-
tases. Many patients with urachal carcinoma will be
eligible for clinical trials (Question 96). Clinical trials
A carefully planned
experiment to evalu-
47. Are there complementary or alternative
ate a treatment or
therapies that are useful?
medication (often a
new drug) for an
Most alternative therapies have not been well studied,
unproven use.
making it difficult to recommend any specific therapy.
Supplements like bovine and shark cartilage are often
touted as being active against cancer, but no good stud-
ies have yet been completed that show a convincing
effect. Herbal remedies are also available, although
none have been proven to be effective. Any of these
types of treatments can be expensive, and the dangers
are equally unknown. To be effective against cancer, any
treatment must be able to kill cancer cells. If an agent is
potent enough to kill these cells, it should easily be able
to kill normal cells and potentially have serious nega-
tive side effects. Be suspicious of treatments that allege
results with no side effects. Furthermore, if you are on
medications prescribed by your doctor, you need to be
aware of the potential interactions between herbal ther-
apies and those prescription medications.
In the end, we urge you to use caution and common
sense when considering alternative therapies, especially
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dietary supplements and herbal medications. The
National Institutes of Health maintains a website of
complementary and alternative medicine at http://
nccam.nih.gov/ that provides information and links to
other resources. You can also see our appendix for
more sources of information.
48. Do I need to seek treatment right
away after being diagnosed with invasive
bladder cancer?
Once you have Once you have been diagnosed with invasive bladder
been cancer, it is very important to seek treatment right
diagnosed away. The goal of bladder cancer treatment is to stop
with invasive the cancer before it spreads outside of the bladder.
bladder cancer, Surgery can cure only when all of the cancer is
it is very removed. If the tumor has spread outside of the blad-
important to der, even in microscopically small amounts, then sur-
seek treatment gery will usually not be enough. A delay in treatment
right away. after your initial diagnosis may increase the risk that
the tumor will spread outside of the bladder.
After diagnosis, several tests still must be performed
before surgery. These tests are designed to help ensure
that the cancer is confined to the bladder and that you
are in optimal medical condition to get through the
surgery. These tests must all be scheduled and per-
formed and the results reviewed. This usually takes at
least 2 or 3 weeks. Although the less time that elapses
before surgery the better, it is generally agreed that the
process should take less than 6 weeks to avoid signifi-
cantly increasing the risk of spread. Thus, if you delay
starting the process you will only add to the duration of
time that passes before treatment. There is no need to
panic, and remember that the process will usually take
several weeks. However time is indeed of the essence.
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PART FOUR
Intravesical
Therapy
What is intravesical therapy?
What is the difference between therapeutic
and prophylactic intravesical therapy?
What is immunotherapy?
More . . .
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49. What is intravesical therapy?
Intravesical therapy is treatment for bladder cancer that
is applied directly into the bladder. It can be either
Immunotherapy immunotherapy or chemotherapy. The most common
Therapy designed to
type of immunotherapy is BCG. BCG is immunother-
activate the body s
apy that may be given with or without interferon. Sev-
own immune system
eral chemotherapeutic agents are also available, including
to fight disease.
mitomycin C, thiotepa, doxorubicin, epirubicin, valrubicin,
and others. These are all administered directly into the
bladder through a catheter. The medications are then
able to act on the surface of the bladder without exposing
the rest of your body to potentially harmful medications.
(See Questions 51 and 64 for details on immunotherapy
and chemotherapy.)
50. What is the difference between therapeutic
and prophylactic intravesical therapy?
Intravesical therapy is said to be therapeutic when it is
used to kill visible tumor cells. Some patients are unable
to have their entire tumor(s) removed with TURBT
because of the location or extent of the tumor. Intravesi-
cal therapy in these patients is designed to kill the
remaining tumor and is thus called therapeutic. Intra-
vesical therapy is also considered therapeutic when used
to treat carcinoma in situ.
Many patients receiving intravesical therapy have already
had their entire tumor removed by TURBT. The goal
Prophylactic of this type of treatment is prophylactic (i.e., trying to
Preventive measure prevent the growth of new tumors). Most experts believe
or medication.
that this type of treatment actually works not by pro-
tecting you from the development of new tumors, but
by eradicating microscopic tumors that would eventually
have grown into larger tumors.
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51. What is immunotherapy?
Immunotherapy takes advantage of the methods used
by our own immune system to attack cancer cells. There Immune system
are two types of immunotherapy: passive or active. Pas- The body system,
made up of many
sive immunotherapy involves the direct administration
organs and cells, that
by doctors of molecules or cells to a patient and requires
defends the body
against infection, dis-
no involvement by the patient s own immune system.
ease, and foreign
Active immunotherapy attempts to activate the patient s
substances. The
immune system to attack the cancer cells.
immune system is
often stimulated in
specific ways to fight
Immunotherapy could someday help to avoid the toxi-
cancer cells.
city of chemotherapy and radiation for a variety of dif-
ferent types of cancers. For most cancers, this type of
therapy is very new, and research is still ongoing. For
bladder cancer, one type of immunotherapy, called
BCG therapy, has been available for many years with
excellent results.
52. What is BCG?
BCG stands for Bacillus Calmette-Guerin. It was
developed in the 1920s. Some readers may recognize
this as a vaccine for tuberculosis, as it is still used for
this purpose in many countries. BCG is a live, attenu- Attenuated
ated (weakened) form of the bacteria that causes tuber- To reduce in force,
value, amount, or
culosis. Although it is too weak to cause tuberculosis,
degree; to weaken.
it does activate the immune system. When it is given
With respect to a
bacteria/virus, to
as a vaccine, it causes antibodies to be made that are
reduce the infectivity
active against the usual form of tuberculosis, thereby
of a pathogenic
preventing most patients from acquiring the disease.
microorganism.
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