Bladder Cancer Treatment Options

Surgery for Bladder Cancer

Common surgical procedures for bladder cancer include:

Transurethral Resection of Bladder Tumor (TURBT)

This procedure is used to look into the bladder and remove a sample of the tumor for biopsy or the entire tumor, if possible. The urologic surgeon inserts a cystoscope (a thin lighted tube) into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity.

Partial Cystectomy

This is a surgery to remove only part of the bladder. This may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.

Radical Cystectomy

A surgical procedure that removes the bladder and any lymph nodes, and all or part of nearby organs that contain cancer. This would be the prostate and seminal vesicles in men, and the uterus, ovaries, and part of the vagina in women.

Urinary Diversion

When the bladder must be removed, the surgeon creates another way to store and pass urine. It may involve redirecting urine into the colon, using catheters to drain the bladder, or making an opening in the abdomen that connects to a bag outside the body for collecting urine. The right option for you will be discussed with the surgeon.

Radiation Therapy for Bladder Cancer

External beam radiation therapy can be used for several different purposes when treating bladder cancer including:

Treatment after surgery to be sure all the cancer cells in the area have been destroyed.
To kill the cancer cells so that a bladder removal surgery (cystectomy) can be avoided.
An alternate option instead of surgery, for those with earlier-stage bladder cancer who aren’t able to have surgery or chemotherapy.
To kill bladder cancer cells that have grown outside of the bladder.

Medical Oncology Therapies for Bladder Cancer

Chemotherapy, immunotherapy, and targeted therapy can be used as part of the bladder cancer treatment plan.

Intravesical Therapy for Early-stage Bladder Cancer

Intravesical therapy can be used to treat bladder cancer that has not invaded the muscle wall. A liquid drug is placed inside the bladder rather than giving it by mouth or injecting it. The drug is given through a tube (urinary catheter). The drugs inserted in the bladder could be chemotherapy or immunotherapy.

Systemic Chemotherapy

Given through an IV or in pill format, these drugs are used to shrink tumors before surgery and/or to be sure any remaining cancer cells are destroyed after surgery. Different treatments are chosen based on whether radiation is being used as part of the treatment plan.

Immunotherapy for Bladder Cancer

Cancer cells are able to trick the body into thinking they’re healthy by “hiding” from the immune system’s defenses. Immunotherapy drugs use the body’s immune system to identify and attack cancer cells by making it possible for the body to identify the cancer cells and kill them like it would other foreign substances in the body. This can be given in the bladder directly or through an IV.

Bladder Cancer Targeted Therapy

Researchers have identified specific genetic changes that can lead to bladder cancer. Drugs have been developed to target these changes and stop the cancer from growing. Tests will be run to determine if there are gene mutations that can be treated with one of these drugs.

Free Guide for Newly Diagnosed Bladder Cancer Patients

Get helpful tips on what to expect and how to prepare your mind and body for bladder cancer treatment.

Treatments by Stage of Bladder Cancer

The right treatments at each stage of bladder cancer are largely dependent on whether the cancer is muscle-invasive (MIBC) or non-muscle-invasive (NMIBC).

Stage 0 and I: Non-Muscle Invasive Bladder Cancer Treatments

Low-risk NMIBC: These are single, small, low-grade, papillary (Ta) tumors. Usually, no further treatment is needed for these tumors after they are removed.

Intermediate-risk NMIBC: Because these tumors typically have one concerning feature, such as multiple or larger tumors, high-grade cancer, or cancer growing into the connective tissue layer, intravesical therapy is recommended after the TURBT surgery.

High-risk NMIBC: These NMIBCs typically have more than one concerning feature, such as the tumor being both high-grade and either flat (CIS) or growing into the connective tissue layer, a second TURBT might be done (usually a few weeks after the first one) to help ensure that the cancer hasn’t reached the muscle layer of the bladder wall. The main treatment options after TURBT is intravesical therapy with BCG, weekly for 6 weeks, then less frequently for up to 3 years. If BCG isn’t effective, other treatment options might include bladder removal surgery or immunotherapy.

Stage II Bladder Cancer Treatments

Treatment of stage II bladder cancer usually begins with a TURBT surgery to determine how deeply it has grown into the bladder wall. Additional treatments are usually recommended after surgery, such as:

Chemotherapy before surgery to shrink the tumor
Cystectomy. This can be radical (removal of the entire bladder) or partial depending on where the cancer is located. This procedure can include removal of pelvic lymph nodes for testing.
External radiation therapy if cancer was found in the lymph nodes.
For those who can't have or don't want a radical cystectomy a bladder-preserving trimodality therapy can be used. It includes a more extensive TURBT, followed by chemotherapy and radiation therapy.

Stage III Bladder Cancer Treatments

Treatment of stage III bladder cancer may have spread to the lymph nodes or other areas near the bladder, making systemic treatment necessary to reach all of the cancer cells.

Radical cystectomy with urinary diversion
Chemotherapy before and/or after surgery. This is typically a combination of chemotherapy drugs found to be most effective.
External radiation after surgery, sometimes combined with chemotherapy. Lymph nodes affected by cancer can be directly treated with this therapy.
For those who can't have or don't want a radical cystectomy, a bladder-preserving trimodality therapy can be used. It includes a more extensive TURBT, followed by chemotherapy and radiation therapy.

If the oncologist feels that the patient is at high risk for the cancer to return, they may also use an immunotherapy drug after surgery for up to one year.

Stage IV Bladder Cancer Treatments

Treatment of stage IV bladder cancer varies based on whether it has spread to distant parts of the body.

If the cancer has not spread to distant parts of the body, immunotherapy, sometimes combined with chemotherapy, can be used to shrink the amount of cancer before removing the bladder and creating a urinary diversion.

If the cancer has spread to distant part of the body, chemotherapy and immunotherapy can be used as a first-line of treatment. If the cancer shrinks or disappears, your oncologist may recommend more treatment, such as chemoradiation or possibly surgery to remove the bladder. If surgery isn’t an option or the cancer doesn’t respond, additional treatments like chemotherapy, immunotherapy, or targeted therapy might still help.

Treatments for Recurrent Bladder Cancer

The recommended path forward for patients who have recurrent bladder cancer depends on the patient’s personal preferences, overall health condition, and how extensively the cancer has returned.

If the bladder cancer grows in another part of the bladder, the same treatments used the first time can be used again. If it’s returned to the same area as before, a cystectomy may be necessary to remove the bladder.

If the cancer returns in a distant area of the body it is still going to be treated as bladder cancer, however, surgery is less likely to be effective. Other treatments such as chemotherapy, immunotherapy, and targeted therapy may be used depending on where the tumors have grown and if there is an identifiable gene mutation that can be treated with a targeted therapy drug.

Clinical research trials are also often available through Rocky Mountain Cancer Centers for patients with recurrent bladder cancer. Your oncologist will lay out the various treatment options for you and your family to review and discuss.

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