Intravesical therapy is widely used in practice as an adjuvant treatment for early-stage bladder cancer following surgical transurethral resection. This is because it is a localized treatment that is administered directly into the bladder, thus leading to fewer systemic side effects.
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Despite these advantages, intravesical therapy is associated with a reduced efficacy on any metastases throughout the body.
Treatment overview
The primary goal of intravesical therapy is to eradicate tumors from the localized area in the bladder. This may involve the use of cytotoxic or immunostimulatory agents to eliminate the abnormal cancer cells, depending on the specific case and characteristics of the patient.
This therapeutic approach is a suitable option for early stage cancers that are noninvasive (stage 0) or minimally invasive (stage 1), whereas systemic therapy is preferred for higher stage or metastatic bladder cancer.
For some patients with bladder cancer, intravesical therapy is the only treatment they will need to treat the cancer. This is considered to be preferable, as the therapy is associated with significantly fewer side effects as compared to other treatment modalities.
Procedure
Initially, intravesical therapy involves the application of an anesthetic gel to the urethral area to numb the sensation and allow for the insertion of a catheter into the urethra.
Once inserted, the catheter is gently pushed upwards until it reaches the bladder. From this point, the catheter can then used to administer a liquid drug formulation directly to the bladder, bypassing the oral or intravenous route and thus minimizing any potential systemic effects.
The catheter can then be removed. From here, the patient is advised to refrain from passing urine for the next few hours to allow the medication enough time in the bladder to have an optimal effect. After this time, the patient can relieve themselves as usual, or the urine may be drained with the catheter if still inserted, to eliminate the chemotherapy drug from the body. Care should be taken to ensure that the urine passed in the next 6 hours does not come in contact with the skin, as it may cause an adverse reaction.
Bladder Cancer Treatment: Intravesical Therapy - Urology Care Foundation
Pharmaceutical agents
Immunotherapy agents stimulate the immune system to attack the cancer cells. Some of the different immunotherapy agents that can be administered during an intravesical therapy include Bacillus Calmette-Guerin (BCG) and interferon-alpha (IFN-a).
BCG is the most effective immunotherapy agent for bladder cancer. BCG is a bacterium that attracts the cells of the immune system to the area, which also affect the cancer cells in the bladder. This treatment is usually given in six separate doses at a rate of once a week for a total of six weeks.
Some of the side effects of treatment with BCG may include flu-like symptoms, including fever, chills, and fatigue. In rare cases, BCG can spread throughout the body and cause an infection similar to tuberculosis.
IFN-a is a substance that naturally has a stimulatory effect on the immune system. The side effects of treatment with IFN-a may include muscle aches, bone pain, headaches, nausea, vomiting, fatigue, and loss of concentration.
The cytotoxic agents used in intravesical chemotherapy target the cell division process of all cells in the area. There are a wide range of cytotoxic agents that may be indicated for this specific treatment approach, including mitomycin C, valrubicin, doxorubicin, epirubicin, and gemcitabine. The primary side effects associated with this therapy include irritation and burning, both of which are typically localized to the bladder.
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Further Reading