Penn medical oncologists are members of the bladder cancer team whose approach to cancer is to treat the entire individual — not just the disease.
Medical oncologists are physicians who specialize in the diagnosis and treatment of cancer. Penn oncologists work closely with radiation and urologic oncologists to treat bladder cancer patients with medical therapies such as chemotherapy, immunotherapy, and targeted therapy. Our medical oncologists are part of a multidisciplinary team of cancer specialists that work with other disciplines to create an individualized treatment plan for those with bladder cancer.
Chemotherapy uses drugs to attack cancer cells, slowing or stopping their ability to grow and multiply. Chemotherapy is usually given:
- Orally: taking pills or capsules by mouth
- Intravenously (IV): injecting medication into a vein
- Intramuscularly (IM): injecting medication into a muscle
- Subcutaneously: injecting medication under the skin
Chemotherapy is not a "one-size-fits-all" cancer treatment. The wide range of cancer-fighting drugs attack different types of cancer cells at varying stages of cell development. Our medical oncologists are experts at determining which drug or combination of drugs will be the most effective in treating the various types of cancer.
Immunotherapy is designed to repair, stimulate or enhance the immune system's responses. The body's immune system helps to prevent disease, but it can also play a role in preventing cancer from developing or spreading.
The goal of immunotherapy is to enhance the body's natural defenses and its ability to fight cancer. Immunotherapy often has fewer side effects than conventional cancer treatments because it uses the body's own immune system to:
- Target specific cancer cells, thereby potentially avoiding damage to normal cells
- Make cancer cells easier for the immune system to recognize and destroy
- Prevent or slow tumor growth and spread of cancer cells
Targeted molecular therapy is a type of personalized medical therapy designed to treat cancer by interrupting unique molecular abnormalities that drive cancer growth. Targeted therapies are drugs that are designed to target a specific biochemical pathway, or the way cancer grows, that is key to the development, growth and spread of a tumor.
Because not every cancer develops in the same way in every person, targeted molecular therapy is often personalized to the individual. In some cancers we know what the molecular targets are. But in other cancers these targets are still being identified. Even in a given type of cancer, not every cancer has the same molecular targets. Identifying the molecular targets in any given patient's cancer requires working closely with pathologists to carefully analyze the cancer specimen.
Targeted cancer therapies like targeted molecular therapy, give medical oncologists a better way to customize cancer treatment. Advantages of the therapy include:
- Potentially less harm to normal cells
- Potentially reduced side effects
- Improved effectiveness
- Improved quality of life
Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk that cancer will recur (come back).
Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment occur every day at Penn, giving patients hope that even greater discoveries lie ahead.
Through clinical trials:
- Diagnosing cancer has become more precise.
- Radiation and surgical techniques have advanced.
- Chemotherapy treatments are more successful.
- Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
- Strategies to address the late effects of cancer and its treatment are improving quality of life.
Radiation therapy uses high-energy X-rays to kill cancer cells. At Penn Radiation Oncology, we use the latest equipment and technology available to treat bladder cancer. Our radiation oncologists are recognized leaders in techniques that target radiation precisely to the treatment area while sparing normal tissue.
Our patients with bladder cancer have access to new and advanced treatment options and ongoing clinical trials in radiation therapy including proton therapy. As part of our commitment to advancing cancer care in patients, radiation oncologists are also researching how radiation treatment affects quality of life as well as novel biomarkers of bladder cancer treatment response.
Image-Guided Radiation Therapy (IGRT)
Image-guided radiation therapy (IGRT) uses frequent imaging during a course of radiation therapy to improve the precision and accuracy of the delivery of radiation treatment.
In IGRT, the linear accelerators (machines that deliver radiation) are equipped with imaging technology that take pictures of the tumor immediately before and during the time radiation is delivered. Specialized computer software compares these images of the tumor to the images taken during the simulation to establish the treatment plan. Necessary adjustments can then be made to the patient's position and/or the radiation beams to more precisely target radiation toward the cancer and avoid exposure to the healthy surrounding tissue.
Intensity-Modulated Radiation Therapy (IMRT)
Our radiation oncologists at the Abramson Cancer Center use intensity-modulated radiation therapy (IMRT) to treat bladder cancer. This advanced mode of high-precision radiotherapy utilizes computer-controlled linear accelerators to deliver precise radiation doses to tumors or specific areas within the tumors.
Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells. Using 3-D computed tomography (CT) images in conjunction with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumor by controlling, or modulating, the intensity of the radiation beam in multiple small volumes. The therapy allows higher radiation doses to be focused on regions within the tumor while minimizing the dose to surrounding normal critical structures.
Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. At Penn Medicine, our patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at the Abramson Cancer Center.
Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.
Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. These particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered through each burst of radiation.
Surgery is an essential treatment for patients with bladder cancer. Even if surgery removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any remaining cancer cells. Treatment given after surgery to lower the risk that the cancer will come back is called adjuvant therapy.
Different surgical approaches to bladder cancer depend on if the bladder cancer is muscle invasive, or non-muscle invasive (superficial).
Transurethral resection is used for bladder cancer that is non-invasive, or has not spread to the muscle tissue. In a transurethral resection, a thin, lighted tube called a cytoscope is inserted into the bladder through the urethra. A tool is then inserted through the scope to remove the cancer or tumor. The procedure is done through the urethra without an incision or scar.
If the bladder cancer is invasive, or has spread to the muscle, a cystectomy may be performed. A cystectomy is surgery to remove the bladder and any lymph nodes or nearby organs that may have cancer. Penn surgeons perform more cystectomies than any other hospital in the Philadelphia region and many cystectomies are performed via robotic-assisted surgery.
In robotic-assisted surgery, the surgeon sits at a computer console and controls the robotic arms. Robotic surgery has advantages such as less blood loss, and quicker recovery.
While these technological advantages are significant, a surgeon's skill and experience remain the most important elements for achieving positive outcomes. At Penn, we have one of the most experienced robotic-assisted surgery teams in the world. This experience, an understanding of the body and bladder cancer, and dexterity of the robot's tools have helped Penn Urology rank the highest in the Philadelphia region, and among the nation's best.
In a radical cystectomy, the entire bladder is removed along with nearby lymph nodes and organs that contain cancer cells. In men, this may include the prostate and seminal vesicles. In women, this may include the uterus, ovaries or part of the vagina. When indicated, Penn surgeons are also highly experienced at performing cystectomy without removal of the vagina, uterus and ovaries. In doing so, sexual function is often preserved. If a radical cystectomy is performed, the surgeon will create another way for urine to pass through the body. Typically, chemotherapy is given before a radical cystectomy because it helps shrink the tumor and increases the likelihood of a complete resection.
In a partial cystectomy, only part of the bladder is removed. This surgery may be performed for patients who have cancer that has only invaded part of the bladder and muscle tissue. Partial cystectomy offers the advantage of allowing patients to keep part of their bladder without the need for urinary diversion.
Ileal Continent Urinary Diversion
Urinary diversion is surgery that creates a new way for the body to store and pass urine. In an ileal urinary diversion, the patient's ureters are surgically removed from the bladder and joined to the intestine in order to drain the urine into a detached section of the ileum, or small intestine. The end of the ileum is then brought out through an opening, or a stoma, in the abdominal wall. The urine is collected in a bag attached to the outside of the body that must be periodically emptied.
When a radical cystectomy is performed, and if the cancer hasn't spread too far, it is often possible to create a new bladder, also called a neobladder, using tissue from the intestines.
Neobladders are positioned inside the body in the same position as the original bladder. The kidneys will filter as they always did and deposit urine into the neobladder, which holds the urine until the patient is able to release it. Many patients are able to learn how to control the release of urine from the neobladder much as they did with a normal bladder. If this is not possible, the patient must insert a catheter to empty the neobladder. This approach is possible if the patient has full kidney and liver function and no cancer in the urethra.
An Indiana pouch is another form of continent urinary diversion alleviating the need for an external urinary appliance. A urinary pouch is made from the patient's intestine, but instead of connecting the urinary reservoir to the urethra like neobladders, the patient is catheterized through the pouch via a small stoma on the skin.
In addition to standard treatments and clinical trials, you may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.
Pelvic Floor Rehabilitation
Pelvic floor rehabilitation physical therapy is a type of non-invasive therapy that focuses on the muscles of the pelvic floor. This specialized technique utilizes both internal and external stretching and release techniques, strengthening exercises, education, and modalities to improve muscle and tissue function along the floor of the pelvis.
Integrative Medicine and Wellness Programs
At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.
Cancer specialists at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.
The Abramson Cancer Center's range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being.
The Joan Karnell Supportive Care Program at Pennsylvania Hospital offers an extensive variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.
The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.
The Supportive Oncology Clinic helps to manage cancer-related symptoms. Integrative support programs include:
Support groups and educational programs are available at Pennsylvania Hospital and the Abramson Cancer Center throughout the year.
Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.
Palliative care can be used to complement traditional cancer therapies, or can be used when curative therapies are no longer an option to treat symptoms and improve quality of life. Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end-of-life care.
Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families, and provide emotional and spiritual support to enhance personal growth.
Penn Home Care and Hospice Services
Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:
Penn Home Care and Hospice Services offer an array of specialized therapies and medications for patients with cancer and cancer-related conditions.