Chemotherapy

Urinary bladder is a muscular sack which receives , stores the urine and release urine through the distal ( lower) urinary tract. Bladder cancer is a cancer which begins in the lining of the walls of the urinary bladder.

Radical Cystectomy is surgery (operation) performed to remove enlarged (overgrown) urinary bladder and surrounding tissues . Tissues surrounding urinary bladder include the prostate, the seminal vesicles and nearby lymph nodes. This procedure can completely cure cancer of urinary bladder that is localized ( restricted only to prostate gland).

Prior to surgery, chemotherapy is used for shrinking the tumor cells. Combined radiation and chemotherapy can also be administered before and after surgery. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The medication is given into a vein (intravenously).Cytotoxic drugs circulate in the bloodstream and can reach cancer cells anywhere in the body.

Safety:

If cancer has spread outside the bladder to surrounding tissue, organs or other parts of the body, chemotherapy is recommended to arrest the spread and growth of cancer cells. This will help reduce symptoms in many patients. The choice of cytotoxic( chemotherapy) drug depends on stage of cancer, its spread, other physical and biochemical parameters of patient.  It could be monotherapy( one drug) or combination of drugs.

Many patients are worried about chemotherapy due to its potential side effects, however, these side effects can be minimized or controlled by use of prescribed. medicines.

Length of treatment :

Chemotherapy is administered by oncologist ( physician) in cycles under supervision. Patient has to be admitted in hospital ward for each cycle of treatment. This is followed by a compulsory rest period usually at home to allow the body to tolerate the medication ( cytotoxic) and recover for next cycle. Each chemotherapy cycle lasts for a few weeks ( 2-3 weeks).

Diagnosis:

Following parameters are strictly monitored before and after each cycle of chemotherapy :

  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)

Treatment:

Chemotherapy is advised for advanced bladder cancers, which have spread ( metastasized ) to distant parts of the body like kidney, bone, uterus, etc.

Treatment prior surgery or radiotherapy is usually 3 cycles. Chemotherapy after surgery or radiotherapy, or combined with radiotherapy, can be 6 or more cycles.

When chemotherapeutic drugs are administered without radiation, the multiple combinations are include:

  • Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (called MVAC)
  • Gemcitabine and cisplatin
  • Carboplatin and either paclitaxel or docetaxel (for patients with poor kidney function)

Alone Cytotoxic drugs can be used or in combination with radiation, the most common drugs used include:

  • Cisplatin
  • Cisplatin plus fluorouracil (5-FU)
  • Mitomycin with 5-FU

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • The urine culture analysis should be negative.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of severe lung/ heart conditions, it is advisable to exercise extra caution before and during the procedure

Procedure:

Chemotharpy treatment is administered in the outpatient department, where there are specialist (onco-physician) and specialist chemotherapy nurses. Each chemotherapy drug is injected through a small tube called a cannula placed into one of the veins, or patient may be given the drugs through intravenous drip slowly for a longer time.

Patient can be sent home after treatment depending upon stage of disease, combination of drugs with radiation and general condition of the patient. It is advisable to stay in hospital for a day or two to monitor vital signs .

Blood tests are done in laboratory before each cycle of treatment. Test reports are assessed before next cycle, doses, and combination are planned. Blood tests will reveal the kidney function and the different counts of blood cells. This is mandatory since, low blood counts could predispose patients to various infection, or external bruising and /or internal bleeding. If the blood cell count is low , next treatment cycle may be put on hold for a week or so, or drug dose may be lowered till blood counts return to satisfactory level.

Patient is thoroughly assessed clinically and with laboratory test to determine the efficacy of chemotherapy. After the course of chemotherapy (or during the cycles),  cystoscopy or CT scan is done to see if the cancer has shrunk.

Risks:

  • Nausea and/ or vomiting
  • Increased risk of infection (due to low count of white blood cells)
  • Mouth sores
  • Reduced or Loss of appetite
  • Sudden Hair loss
  • Diarrhea or constipation
  • Bleeding or bruising after minor cuts or injuries (because of low blood
  • Platelets cells)
  • Fatigue (feeling of weakness due to anaemia)
  • Early menopause
  • Peripheral neuropathy
  • Leukemia

Follow- up:

  • Emergency Follow up:
  • Chest pain/ breathing difficulty.
  • Vomiting/ nausea
  • Worsening pain .
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.
  • Hospital stay for up to one week after radical Cystectomy.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.