Our urology department offers an extensive range of treatments for bladder cancer. The team includes consultant urologists, oncologists, radiologists, specialist nurses and nurse practitioners. As they are all present in the bladder cancer clinic, each patient receives an individual treatment plan.
Depending on the stage and grade of the tumour, a number of treatment options for bladder cancer may be discussed.
- Trans-urethral resection of bladder tumour (TURBT) - this involves removing the tumour with a telescope passed down the urethra (water pipe).
- Blue light cystoscopy.
- Instillation of chemicals (BCG or Mitomycin) into the bladder to try and prevent recurrence of the cancer. See below for information about a current BCG supply problem.
- Radical cystectomy (bladder removal). This can either be done open, laparoscopic (key-hole) or with robotic-assisted surgery. See below for more information, or see the urology leaflets page.
- Radiotherapy – x-rays are targeted at the bladder over a number of treatments to try and destroy the cancer cells.
- Chemotherapy – the use of anti-cancer drugs given intravenously (into a vein), to destroy cancer cells.
The majority of bladder tumours are managed using cystoscopic techniques (surgeons operate through a telescope placed into the bladder). More aggressive tumours may need open surgery or robotic-assisted laparoscopic surgery using the da Vinci surgical system. Some patients with small recurrent bladder tumours may be suitable for treatment under local anaesthetic using a flexible cystoscope and a holmium laser.
We have a very active bladder cancer research programme which our patients have supported enthusiastically. Our work has been presented at national and international meetings and has won many awards. Our focus is to improve the initial endoscopic surgical treatment of bladder cancer.
Blue light cystoscopy treatment
Blue light cystoscopy is a new technique offered to many patients with non-muscle invasive bladder cancer and to all patients who have multiple recurrent tumours. It may be particularly useful for patients with suspicious cells in their urine.
A chemical is put into the bladder one hour before the cystoscopy. Surgeons then view the bladder using blue light as well as standard white light cystoscopy. Cancer cells absorb the blue light and glow red, so they are easier to see.
We have conducted a large randomised control trial looking at blue light cystoscopy treatment, and were awarded one of the top cancer prizes by the European Urology association for this work.
Guy's offers a tertiary referral service for other hospitals to refer such patients.
Local anaesthetic laser ablation under blue light
Many patients with bladder tumours are very frail and repeated operations under general anaesthetic are potentially dangerous for them. Consultant surgeon, Miss Kay Thomas, has led the introduction of treatment under local anaesthetic, using a laser under blue light control. This allows many patients to be treated in the urology centre without needing to be admitted to hospital.
EMDA Mitomycin C
In 2010 we began a new treatment regimen for patients with high grade non-muscle invasive bladder cancer. Standard treatment for these patients was previously weekly instillations of BCG for 6 weeks. We now give them a 9 week treatment course, which combines 6 weeks of BCG with 3 weeks of EMDA (electro motive drug administration) Mitomycin.
EMDA therapy uses an electrical current to enhance the transport of the drug across through the bladder wall and increase its uptake in underlying tissues. Evidence from studies in Italy, conducted by Professor Di Stasi, suggest that the combination treatment is more effective than either treatment alone.
We have completed and published a randomised trial for patients who need a cystectomy (total bladder removal). The CORAL trial looked at the patient's outcomes following a cystectomy, depending on which type of surgery (open, laparsocopic or robotic). This unique first in the world trial compared open surgical removal of the bladder (which has been the standard surgical technique for over 65 years) with keyhole techniques of laparoscopic and robot assisted approaches (CORAL Trial). The robot assisted cystectomy programme was established in 2004 when it was the first programme of its kind in UK and Europe.
The trial demonstrated the known benefits of keyhole surgery in terms of reduced blood loss, shorter length of stay and relatively quicker recovery compared to open approach. However there was no significant difference in 90day complication rates (Clavien grade) between the three trial arms.Thus in suitable patients this approach will be offered as standard of care in our unit. This trial has been published in the journal 'European Urology'.