Bladder Cancer

• Ultrasound: This non-invasive imaging technique checks for the presence of tumours inside the bladder and helps determine their size and location.
• CT scan or MRI: These high-resolution imaging tests help assess whether the cancer has spread to surrounding tissues or other organs.
• Intravenous pyelogram (IVP): By injecting contrast dye into a vein, an X-ray examination can be performed to visualize the bladder, kidneys, and ureters, assisting in detecting the presence of tumours.

Surgery is the primary treatment for bladder cancer, especially for early-stage and localized cancers. Depending on the tumour's size, location, and extent of invasion, standard surgical procedures include:

• Transurethral Resection of Bladder Tumour (TURBT):
  This procedure is used for early-stage non-muscle-invasive bladder cancer. A cystoscope is inserted through the urethra into the bladder, and the tumour is scraped off the bladder wall using an electrical loop or laser. The removed tissue is then examined to determine the nature of the tumour. TURBT is the standard method for diagnosing and treating early-stage bladder cancer. Post-surgery, bladder instillation of medication (such as BCG therapy) may be required to prevent cancer recurrence.
   
• Radical Cystectomy:
  This is used for muscle-invasive bladder cancer or locally advanced cancer. The surgery involves removing the entire bladder and reconstructing the urinary tract. Reconstruction options include creating a new bladder from a segment of the intestine (neobladder surgery) or using an external urinary pouch. This procedure is suitable for cancers that have invaded deep bladder muscle or for more extensive cancers.
   
• Partial Cystectomy:
  This surgery is performed when the tumour is confined to a small bladder area. Only the portion of the bladder containing the tumour is removed, preserving the healthy part. This allows for partial bladder function to be retained, but its use is limited in some instances.

Chemotherapy uses anti-cancer drugs to kill or inhibit the growth of cancer cells and can be administered locally or systemically:

• Local Chemotherapy: Chemotherapy drugs are directly instilled into the bladder, targeting the tumour's surface. This is mainly used for early-stage non-muscle-invasive cancer. It has fewer side effects but is less effective for muscle-invasive or metastatic cancers.
   
• Systemic Chemotherapy: Used for muscle-invasive or metastatic bladder cancer, chemotherapy drugs are delivered through intravenous injection or oral medication, circulating throughout the body. This treatment is usually done before surgery (neoadjuvant chemotherapy) to shrink the tumour or after surgery (adjuvant chemotherapy) to reduce the risk of recurrence.

Immunotherapy leverages the patient's immune system to target cancer cells.

• BCG Immunotherapy (Bladder Instillation Therapy):
  BCG (Bacillus Calmette-Guerin) is instilled into the bladder to activate the local immune system to attack cancer cells. This is the most commonly used immunotherapy for non-muscle-invasive bladder cancer, particularly for preventing recurrence in high-risk early-stage cancers.
   
• PD-1/PD-L1 Inhibitors:
  These are used for advanced or recurrent bladder cancer, particularly in patients who do not respond to traditional treatments. PD-1 and PD-L1 inhibitors block the mechanisms that allow cancer cells to evade immune system attacks, enabling the immune system to recognize and attack the cancer cells. This therapy has shown significant efficacy in some patients with metastatic or recurrent bladder cancer.