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Bladder cancer treatments

A multidisciplinary team of bladder cancer experts treat bladder cancer using various techniques, including immunotherapy, surgery, radiation therapy and chemotherapy. Bladder cancer treatment plans are developed based on different factors, such as the stage of the disease and the patient’s overall health.

Surgery

Surgery is typically the first bladder cancer treatment option for early-stage disease because tumors have likely not spread to other areas of the body.

Surgery may be performed for bladder cancers that have recurred or metastasized (spread). For some patients, a bladder-preserving approach may be the recommended option. For others, removal of the entire bladder may reduce the risk of a subsequent cancer. Doctors will discuss types of bladder cancer treatments with you to help you make an informed decision about your care. Our surgical oncology experts are experienced in a variety of procedures, and we proactively manage the side effects of bladder cancer surgery.

Depending on the stage of the disease, your doctor may recommend one or more of the following bladder cancer surgical procedures:

Transurethral resection: Also called “transurethral resection of the bladder tumor,” this surgery is common for early-stage bladder cancers or those confined to the superficial layer of the bladder wall. This bladder cancer surgery is performed by passing an instrument through the urethra, which avoids cutting through the abdomen. The surgical instrument used for this operation is called a resectoscope. A wire loop at one end of the resectoscope is used to remove abnormal tissues or tumors.

After this procedure, burning the base of the tumor (fulguration) may help destroy remaining cancer cells. Alternatively, a high-energy laser may be used. With either approach, a cytoscope is used to view the inside of the bladder during the procedure.

Cystectomy: This bladder cancer surgical procedure may be used to remove the entire bladder or portions of it. Sometimes, the bladder may be accessed through an incision in the abdomen. It may also be possible to perform laparoscopic surgery. With this approach, several small incisions are made using long, thin instruments, one with a video camera on the end that enables the surgeon to see inside the pelvis. Laparoscopic surgery, also called keyhole surgery, may reduce pain and shorten recovery time.

There are two types of cystectomies:

  • Partial cystectomy: If cancer has invaded the muscle layer of the bladder wall but is not large and is confined to one region of the bladder, then it may be possible to treat by removing only part of the bladder. With this procedure, the portion of the bladder where there is cancer is removed, and the hole in the bladder wall is then closed.

  • Radical cystectomy: If the cancer is larger in size or is in more than one region of the bladder, then the entire bladder may need to be removed. With a radical cystectomy, nearby lymph nodes may also be removed, along with the prostate (for men), and, for women, the ovaries, fallopian tubes, uterus and a small part of the vagina. This type of bladder cancer surgery is an extensive procedure, but it may help remove cancer cells from the body and reduce the likelihood of the disease recurring.

Learn more about urologic oncology for bladder cancer

Immunotherapy

Immunotherapy is designed to stimulate the body's defenses to attack and kill cancer cells. We use two primary types of immunotherapy to treat bladder cancer:

Checkpoint inhibitors work by targeting signaling proteins that allow cancer cells to hide from the immune system. They may also stimulate the immune system to better recognize and attack cancer cells.

Cancer vaccines are given to help prevent certain cancers, but they may also be used to treat bladder and other cancers by boosting the immune system.

Immunotherapy may not be recommended for all patients, and responses to the treatment may vary widely. Immunotherapy may also be used in combination with other bladder cancer treatments such as surgery or chemotherapy.

Radiation therapy

In treating bladder cancer, radiation therapy may be used in combination with chemotherapy and/or surgery to shrink tumors that are causing pain or a blockage, to treat difficult-to-reach tumors in the bladder, or to attack cancer cells that may be left behind after surgery. This treatment may also be an option for patients whose bladder cancer has spread to other parts of the body. Types of radiation therapy used to treat bladder cancer include:

External beam radiation therapy: This procedure is painless and usually performed on an outpatient basis.

Internal radiation therapy: This treatment uses a catheter to carry radioactive materials directly into or near a tumor.

Chemotherapy

Chemotherapy may be a treatment option for bladder cancer in combination with other treatments, such as radiation therapy and/or surgery. Types of chemotherapy used to treat bladder cancer include:

Systemic chemotherapy: This treatment, delivered in pill form or through an injection or infusion, attacks cancer cells throughout the body.

Intravesical chemotherapy: These drugs are delivered through a catheter inserted through the urethra directly into the bladder.

Clinical trials

Clinical trials may offer some bladder cancer patients access to treatments that may not otherwise be available to them. Clinical trials may be an option for some patients with advanced bladder cancer or those who have exhausted standard-of-care treatments. Patients should consult their doctor to determine if they are a candidate for a clinical trial.

Next topic: What are the facts about bladder cancer?