Multiple Opinions Are ‘Crucial’ for Muscle-Invasive Bladder Cancer

“Being open and discussing all the other sides of the disease: the good, the bad and the quality-of-life issues are really important and patient preferences need to be taken into account,” an expert said.

For patients with muscle-invasive bladder cancer, it’s “crucial” to speak with a multidisciplinary team to figure out the best treatment approach, an expert told CURE®, noting that there are both pros and cons to bladder removal and bladder-preserving options.

Muscle-invasive bladder cancer is when a tumor has grown into the deeper layers of the bladder wall, which means it may be more difficult to treat and is more likely to spread, the American Cancer Society defines.

Before patients with muscle-invasive bladder cancer move forward with a radical cystectomy (surgical removal of the bladder and surrounding lymph nodes) or bladder-preserving therapy, it’s worth thinking about the decision carefully, as it can affect factors including their quality of life, sexual outcomes and self-image, Dr. Joaquim Bellmunt told CURE®.

Bellmunt is an associate professor at Harvard Medical School, medical oncologist and director of the bladder cancer center at the genitourinary oncology program at the Dana-Farber Cancer Institute.

Understanding how much the tumor has invaded the bladder wall and the size of the tumor, are also important factors to consider, he said, based on findings from two recent trials.

“[Speaking with a] multidisciplinary team is crucial,” Bellmunt emphasized. “Being open and discussing all the other sides of the disease: the good, the bad and the quality-of-life issues are really important and patient preferences need to be taken into account.”

LEARN MORE: Differentiating Muscle-Invasive, Non-Muscle-Invasive Bladder Cancer

Radical Cystectomy Versus Bladder-Preserving Therapy

Common treatment options for this patient population include a radical cystectomy and bladder-preserving therapy; however, the two are entirely different.

A radical cystectomy means removing the entire bladder “to prevent the disease from spreading,” Bellmunt explained.

He noted that before patients receive radical cystectomies, they will receive cisplatin, a form of chemotherapy, to destroy any surrounding cancer cells to reduce the risk of the cancer coming back and offer a better survival benefit. Nonetheless, when patients have their bladders completely removed, they will also have to wear a bag to collect the urine, which can impact their quality of life and self-image, Bellmunt said.

The other treatment option is bladder-preserving therapy, in which patients receive a “combination of radiosensitizing chemotherapy and radiation therapy,” Bellmunt said. “[This] chemotherapy makes the radiation therapy become much more effective.”

Patients who receive bladder-preserving therapy are able to keep their bladders, meaning they can “continue to urinate using the normal bladder and the disease can be eradicated,” Bellmunt explained.

“The follow-up is very difficult because you have a patient with a bladder, they received radiation therapy and there is some scar tissue in the bladder. Every three months, [patients] need to get scans and get a cystoscopy to see inside the bladder,” Bellmunt said. “So it’s very difficult to make sure that the patients are not having recurrent disease.”

READ MORE: 4 Questions to Ask After a Bladder Cancer Diagnosis

Open Communication Is Key

Having a conversation about treatment options for muscle-invasive bladder cancer with a urologist, radiologist and medical oncologist is recommended, Bellmunt emphasized.

“Each one of us is providing a different point of view. Likely, the radiation oncologist is the one who's going to better explain the way that the treatment is going to work, the potential side effects and so on,” Bellmunt said. “The surgeons are going to tell you what's going to happen with the surgeon risk, obviously going through the lower rates of complications, infection and so on.”

Once patients have met with those two parties, talking with the medical oncologist can provide more insight into quality of life and will help them decide on the most appropriate treatment option, said Bellmunt.

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