Bladder Cancer Treatment Options | Rocky Mountain Cancer Centers

Your recommended treatment plan is dependent upon various factors including the location of the tumor and the stage of the disease. Most patients will have some type of surgery to remove the cancerous cells. Additional treatments may be needed if the oncologist feels there could be other cancer cells remaining after surgery.

Surgery for Bladder Cancer

Common surgical procedures for bladder cancer include:

Transurethral resection (TUR) with fulguration:During TUR with fulguration, the doctor 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. This is known as fulguration.
Partial (segmental) cystectomy: This is surgery to remove 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 of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
Radical cystectomy with urinary diversion: A surgical procedure that removes the bladder and any lymph nodes and 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 for the body 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.

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.

Treatments by Stage of Bladder Cancer

Stage 0 (In Situ) Bladder Cancer Treatments

Treatment of stage 0 may include the following:

Transurethral resection with fulguration.
Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
Segmental cystectomy.
Radical cystectomy.
A clinical trial of photodynamic therapy.
A clinical trial of biologic therapy.
A clinical trial of chemoprevention therapy given after treatment so the condition will not recur (come back).

Stage I Bladder Cancer Treatments

Treatment of stage I bladder cancer may include the following:

Transurethral resection with fulguration (TURBT).
Intravesical immunotherapy or chemotherapy may be used after the TURBT.
Segmental or radical cystectomy if all the cancer wasn’t removed during the TURBT.

Stage II Bladder Cancer Treatments

Treatment of stage II bladder cancer may include the following:

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.
Chemotherapy before surgery to shrink the tumor
External radiation therapy if cancer was found in the lymph nodes
A repeated transurethral resection with fulguration (TURBT), with radiation and chemo afterwards.

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 III Bladder Cancer Treatments

Treatment of stage III bladder cancer may include the following:

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.
Chemotherapy before and/or after surgery
External radiation after surgery, sometimes combined with chemotherapy.

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 may include the following:

Chemotherapy to start killing cancer cells in distant areas of the body. This reduces the chance for additional distant tumors.
Radical cystectomy, although the goal of this surgery is not to remove all of the cancer. This is very hard to do at Stage IV.
External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).
Chemotherapy alone or with radiation therapy
Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.

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.