Deciding on A Treatment for Early-Stage Bladder Cancer
One of the most challenging aspects of bladder cancer is deciding on a treatment path when the diagnosis is Stage T1, high grade. This staging means the tumor has grown into the lamina propria (the layer of blood vessels and cells that is situated between the bladder lining and the muscle wall), and it could next invade the muscle wall.
Typically, bladder cancer is diagnosed via cystoscopy and then a Transurethral Resection of a Bladder Tumor (TURBT). This means the tumor is basically scraped out and then studied closely under a microscope by a pathologist who identifies the stage.
High grade bladder cancer
High grade bladder cancer is a cancer that has a likelihood of becoming more aggressive in the future and potentially life threatening. Some patients can be treated just with injections into the bladder of BCG and this is enough to prevent future recurrences of bladder cancer.
When the cancer keeps returning
Other patients receive many of these treatments but the cancer keeps returning or it progresses into the muscle wall. This is when a radical cystectomy might be recommended. This treatment landscape has recently been further complicated by the proliferation of clinical trials testing immunotherapy drugs (already F.D.A. approved for metastatic cancer) for non-muscle invasive cancer.
Difficult decisions at every stage
The bladder cancer patient faces difficult decisions at every stage of this disease. A radical cystectomy is a major surgery that has a quality-of-life impact. And it is no guarantee that the cancer will not return. Cancer cells can escape the bladder long before it is removed. But if the bladder remains in the body and the cancer is progressing through the bladder wall, the patient is nearly certain to end up with metastatic disease.
How aggressively should it be treated?
The question that challenges many patients early on is how aggressively to treat non-muscle invasive high-grade bladder cancer. BCG or some combination of it plus immunotherapy may be enough to prevent further development of the cancer.
The problem is that doctors simply don’t know which patients have a cancer that will progress and which patients can be cured just with BCG.
Clarifying your treatment options
So, for patients who find themselves in this situation, what factors should they consider in deciding on a treatment path? As a patient advocate, I don’t offer medical office but I can tell you the kind of questions we asked when my first husband Ahmad was diagnosed. Maybe these can help you in clarifying your options:
- Has the patient gotten a second opinion both from a urologist and a pathologist with significant experience in diagnosing, staging, and treating bladder cancer?
- Are the opinions consistent?
- Is the patient willing to tolerate frequent visits to the doctor for injections of BCG and the related side effects?
- Is the patient open to considering a clinical trial?
- Is the patient healthy enough for major surgery?
- Can the patient cope emotionally with the idea of losing his or her bladder?
- Can the patient cope with the uncertainty of whether BCG will work and the options if it doesn’t?
These are just some questions to consider when deciding on a treatment path. There is no right answer. It is a highly personalized decision. Whatever path is chosen, the patient should feel comfortable with the doctor and with the doctor’s rationale for the treatment chosen.