The treatment options are decided depending on the stage of the disease when it is diagnosed. The following is the treatment approach:
Early stage disease: For non-muscle invasive bladder cancer (NMIBC), the approach is to remove all the visible tumors by transurethral resection of bladder tumor (TURBT). To prevent the relapse of the tumor after the surgery, addition of chemotherapeutic agents like mitomycin C, epirubicin, or gemcitabine can be instilled directly into the bladder (intravesical therapy) within 24 hours of the surgery.
Muscle invasive disease: In patients with urothelial carcinoma of the bladder that invades into or through the muscularis propria but with no evidence of metastatic spread, more aggressive therapy are required to achieve cure. These include:
- Bladder sparing chemoradiation
- Bladder sparing partial cystectomy
- Neoadjuvant cisplatin-based chemotherapy
- Adjuvant cisplatin-based chemotherapy
Metastatic disease: in these patients having metastatic urothelial carcinoma, systemic chemotherapy is the most established standard of care irrespective of the primary tumor origin. The chemotherapeutic agents include combination of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC).