Bladder Cancer Treatments

Treatment

Treatment for bladder cancer depends on the stage of the disease, the type of cancer, and the patient's age and overall health. Options include surgery, chemotherapy, radiation, and immunotherapy. In some cases, treatments are combined (e.g., surgery or radiation and chemotherapy, preoperative radiation).

Surgery

In early bladder cancer, the tumor may be removed (resected) using instruments inserted through the urethra (transurethral resection).

Bladder cancer that has spread to surrounding tissue (e.g., Stage T2 tumors, Stage T3a tumors) usually requires partial or radical removal of the bladder (cystectomy). Complications include infection, urinary stones, and urine blockages. In women with T2 to T3a tumors, the standard surgical procedure is radical cystectomy (removal of the bladder and surrounding organs) with pelvic lymphadenectomy. Radical cystectomy in women also involves removal of the uterus (womb), ovaries, fallopian tubes, anterior vaginal wall (front of the birth canal), and urethra (tube that carries urine from the bladder out of the body). Segmental cystectomy (partial removal of the bladder), which is a bladder-preserving procedure, may be used in some cases (e.g., patients with squamous cell carcinomas or adenocarcinomas that arise high in the bladder dome). Urinary Tract Diversion

Until recently, most bladder cancer patients who underwent cystectomy (bladder removal) required an ostomy (surgical creation of an artificial opening) and an external bag to collect urine. Newer reconstructive surgical methods include the continent urinary reservoir, the neobladder, and the ileal conduit.

Complications of the ileal conduit procedure include bowel obstruction, urinary tract infection (UTI), blood clots, pneumonia, upper urinary tract damage, and skin breakdown around the stoma.

What is Bladder Cancer?

The bladder is an expandable, hollow organ in the pelvis that stores urine (the body's liquid waste) before it leaves the body during urination. The urinary tract, made up of the kidneys, ureters, bladder, and urethra, is lined with a layer of transitional cells called the urothelium. The lamina propria separates tumors that have spread into muscle (called invasive cancer) from those that have not (superficial or non-invasive cancers).

Bladder cancers are malignant tumors that begin in the bladder. Different bladder cancers are described by how deep they grow and if they grow into the bladder or through the muscles around the bladder (superficial or invasive).

There are three types of bladder cancer: transitional cell carcinoma, or TCC (about 90% of bladder cancer cases); squamous cell carcinomas (about 8%); and adenocarcinomas (about 2%). All three types can metastasize beyond the bladder.

Bladder Cancer - Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for people who have bladder cancer depends on the stage and grade of cancer. Bladder cancer is usually curable if it is diagnosed while the cancer is still contained in the bladder, and up to 80% of bladder cancers are diagnosed at this early stage.3

Treatment choices for bladder cancer may include:

Surgery to remove the cancer. Surgery, either alone or in combination with radiation therapy, chemotherapy, or biological therapy, is used more than 90% of the time to treat bladder cancer.1

Chemotherapy to destroy cancer cells using medications. Radiation therapy to destroy cancer cells using high-dose X-rays or other high-energy rays. Biological therapy to boost your body's immune system to fight cancer cells. This therapy is commonly used to prevent the return (recurrence) of bladder cancer.

Initial treatment

Surgery is used to treat most stages of bladder cancer.

Transurethral resection (TUR) is used to remove large superficial bladder tumors or tumors that penetrate more deeply into the tissue but have not spread outside the bladder.

Surgical removal of the bladder (cystectomy) is usually done for the most advanced stages of cancer that is confined to the bladder. Cystectomy may also be done for high-grade bladder cancers or when there are multiple tumors in the bladder.

Chemotherapy uses medications to destroy cancer cells. For superficial bladder cancer, the medications may be delivered directly into the bladder using a catheter (intravesically). Radiation therapy, which uses high-dose X-rays or other high-energy rays to destroy cancer cells, is one of the standard treatments for certain types of bladder cancer. Home treatment can help manage some of the side effects of radiation therapy.

Biological therapy is most often used for superficial bladder cancer.