Bladder Cancer - Traditional Chinese Medicine Treatment

Information provided/updated by:
Professor Pang Yi,
Clinical Professor of Chinese Medicine,
School of Chinese Medicine,
Hong Kong Baptist University

Introduction:

In this article, Professor Pang Yi introduces us to how traditional Chinese medicine treats bladder cancer.

A. Overview (including organs, systems, and the use and differences of terms in traditional Chinese medicine and Western medicine)
B. Causes/Symptoms/Diagnosis
C. Treatment

A. Overview (including organs, systems, and the use and differences of terms in traditional Chinese medicine and Western medicine)

Bladder cancer is the most common cancer of the urinary system, with over 90% being urothelial carcinoma, which can be divided into non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). Men and the elderly are high-risk groups for bladder cancer, and painless hematuria is the most common symptom of bladder cancer.

B. Causes/Symptoms/Diagnosis

Traditional Chinese medicine categorizes bladder cancer under "hematuria", "blood strangury", "dribbling urinary block (disease)", etc.

Bladder cancer is a disease pattern characterized by deficiency of the lung, spleen, and kidney, and the presence of heat toxin, stasis toxin, and dampness-heat.

The cause of bladder cancer is not yet fully understood. Smoking and occupational exposure to aromatic amines are the main carcinogenic factors. Drinking arsenic-containing water and chronic local irritation of the bladder mucosa increase the risk of bladder cancer. Treatment with cyclophosphamide, schistosomiasis, and the loss of the P53 anti-cancer gene on chromosome 17 are also related to the onset of the disease.

C. Treatment

The standard treatment for NMIBC is transurethral resection of bladder tumor (TURBt), followed by intravesical drug therapy and regular cystoscopy. 50% to 80% of patients will experience tumor recurrence, and a small number of patients will experience tumor progression.

For MIBC, radical cystectomy (RC), pelvic lymph node dissection, and urinary diversion are currently the most effective treatments. However, the surgery is very complex, with many complications and high risk, and is one of the most difficult and risky surgeries in urology. Robot-assisted laparoscopic RC is becoming a new and very effective treatment for MIBC. Many patients also choose to preserve the bladder with triple therapy (bladder preservation surgery + chemotherapy + radiotherapy, TMT).

In recent years, immunotherapy for bladder cancer has been increasingly valued, and multi-therapy with the addition of immunotherapy has also been added to the basis of TMT. In addition to chemotherapy for advanced metastatic bladder cancer, immune checkpoint inhibitors (ICIs) and targeted drugs FGFR inhibitors have also become new treatment options.

Traditional Chinese medicine treatment is characterized by pattern identification/syndrome differentiation and treatment, according to the clinical symptoms to identify the characteristics of the disease mechanism, and thus determine the therapeutic principle and method of treatment. Reinforcing the healthy qi and eliminating the pathogenic factors is the basic therapeutic principle for treating bladder cancer, and the treatment method should vary according to the emphasis of the syndrome. The treatment should mainly nourish the lung, spleen and kidney, and also clear heat and detoxify, activate blood and resolve stasis, and drain dampness and promote diuresis to eliminate the pathogenic factors, thereby restoring the body's yin-yang balance.

Experimental mechanism studies have found that Chinese medicinal and Chinese medicinal monomers can inhibit cell proliferation by blocking the tumor cell proliferation cycle; promote tumor cell apoptosis and tumor cell autophagy, inhibit tumor cell invasion and migration, and inhibit tumor cell drug resistance. Supplementing modern medical treatment with Chinese medicinal treatment can often reduce the recurrence rate of bladder cancer, alleviate adverse reactions after chemotherapy, improve quality of life, and improve patient prognosis.

Bladder cancer has a better prognosis if it can be detected and treated early. However, the recurrence rate of bladder cancer is very high, and patients still need to be closely followed up and regularly reviewed after treatment. Lifestyle factors such as consuming large amounts of red meat and processed meats, arsenic-containing water, chewing betel nut, and smoking may increase the risk of bladder cancer. Quitting smoking and alcohol, avoiding contact with carcinogenic chemicals, maintaining a positive mood, eating a light diet, eating more fresh vegetables and fruits (such as broccoli, cabbage, cauliflower and kale), and controlling weight can help reduce the incidence of bladder cancer.

(February 2022)