Bladder Cancer

1. Non-muscle Invasive Bladder Cancer (NMIBC) (Stage 0-1): These tumours affect the shallow layers within the bladder and are usually less aggressive. They can often be treated successfully with minimal intervention. The main goal of treatment is organ (bladder) preservation whilst achieving maximal cancer-free rates.
2. Muscle Invasive Bladder Cancer (MIBC) (Stages 2-3): In these cases, the tumour has spread to involve the muscle layers in the urinary bladder wall. These cancers can invade surrounding tissues, making them more aggressive and potentially leading to metastasis.
3. Metastatic (Stage 4): At this stage, bladder cancer has spread beyond the bladder to distant organs. This form is highly aggressive and more challenging to treat.
   
   
   Figure 2: Classification of Bladder Cancer
   

• Not smoking
• Eating a diet rich in fruits and vegetables
• Taking regular exercise
  
• Following safety instructions to avoid exposure if you work with chemicals

1. Transurethral Resection of Bladder Tumour (TURBT): This is a minimally-invasive surgery where a small camera is introduced into the bladder along with tools to remove superficial bladder tumours and obtain specimens for biopsy and testing. No skin incisions are necessary. 
   
2. Intravesical Therapy: This involves introducing medications like Bacillus Calmette Guerin (BCG) and Mitomycin-C into the bladder to reduce the chance of cancer recurrence and maximize the effect of surgery. The medications should be held within the bladder for a period of time before being passed out in the urine. Refer to our leaflet below for more information about BCG.
   
3. Combination Chemotherapy for High-Risk Patients: SGH's dedicated High-Risk Bladder Cancer Clinic, established in October 2023, offers a new treatment option for patients with high-risk non-muscle invasive bladder cancer who are unresponsive to standard therapies or unsuitable for invasive surgery. This treatment combines two existing chemotherapy medications – gemcitabine and docetaxel – delivered directly to the bladder via the urethra monthly for up to 24 months. This approach has shown promising results in many academic institutions, with a reported success rate of about 70% according to overseas studies. It aims to effectively manage the disease and avoids removal of the whole bladder thus, maintaining a better quality of life for patients. These combinatory therapy has also been observed to have fewer side effects compared to standard treatments. We also facilitate research by prospectively enrolling patients into clinical trials and tissue studies to aid better understanding of bladder cancer and develop personalised and cost-effective treatments for every individual patient. 

1. Radical Cystectomy: This major operation involves three main steps
   • Removal of the entire urinary bladder
     
   • Removal of surrounding lymph nodes
     
   • Creation of urinary diversion (either an ileal conduit or a neobladder)
     
     Figure 5: Creation of Ileal Conduit with Urostomy Bag
2. Robotic-assisted Radical Cystectomy: SGH Urology offers this minimally invasive approach, which achieves lower blood loss and transfusion, better pain control, and shorter hospital stay. We perform approximately 30 radical cystectomies a year, with close to 80 robotic-assisted cases performed till date.
   
3. Tri-modal Therapy: For patients not suitable for radical cystectomy, a combination of chemotherapy and radiation therapy may be used.
   
   SGH Urology works closely with medical oncologists and radiation oncologists under the umbrella of National Cancer Centre Singapore (NCCS) to provide patients with the treatment options most suited to their condition.
   
   In some cases, a combination of treatments (e.g., surgery + chemotherapy or surgery + radiation therapy) may be recommended. Immunotherapy may also be used to trigger the body's immune system to fight cancer cells.
   

• Stage of the Cancer: Early-stage bladder cancers (such as superficial or non-invasive types) are more likely to be curable. Advanced stages, where the cancer has invaded deeper layers or spread to other organs, can be more challenging to treat.
• Type of Bladder Cancer: The most common type is transitional cell carcinoma, which can vary in aggressiveness. Other less common types may have different prognoses.

Treatment Options which may include:

• Surgery: Removing the tumour (transurethral resection) or the entire bladder (cystectomy).
• Chemotherapy: Can be used before surgery (neoadjuvant) or after (adjuvant) to kill remaining cancer cells.
• Immunotherapy: Helps the immune system fight the cancer.
• Radiation Therapy: Sometimes used, especially if surgery is not an option for the patient