There are many options when it comes to treatment. You may need one type or several. Your treatment may also change over time. Here are the common treatments for bladder cancer:
Surgery is the most common treatment for bladder cancer. Surgeries include:
Transurethral resection of bladder tumor (TURBT): This is the most common surgery for early stage bladder cancer. It involves your doctor taking a biopsy along with some normal muscle tissue. The procedure may be done for repeat biopsies or to remove any remaining cancer after a biopsy.
Cystectomy: This procedure is done for invasive bladder cancer. Partial cystectomy is removal of part of the bladder. Radical cystectomy is removal of the entire bladder.
If you have a radical cystectomy, you will need some type of reconstructive surgery to restore urine flow. There are three options:
Incontinent diversion. This surgery converts a section of your intestine into a bladder. Urine flows through an opening in your belly — called a stoma — and into a bag that you wear over the stoma.
Continent diversion. This is a similar surgery, but the stoma has a valve. You do not need a bag. You insert a catheter to drain urine.
Neobladder. This procedure creates a new bladder, made from your intestine and connected to your urethra. You will pass urine through your urethra. You will not have a stoma.
All surgery can have side effects. These may include reactions to anesthesia, bleeding, infection, blood clots and damage to other organs. TURBT generally has mild side effects, such as blood in your urine and pain when passing urine. These side effects usually do not last long.
Side effects from cystectomy or reconstructive surgery can be more serious. In addition to the usual side effects of surgery, you could have leaking or obstruction of urine flow. Also, stones may form in a reconstructed bladder. Both men and women also may experience issues with sexual functioning.
Chemotherapy involves using a drug to kill cancer cells. Often, a combination of drugs is used. Some people have just chemotherapy, but often it's used along with other treatments. Chemotherapy is sometimes done before surgery to shrink the tumor. Chemotherapy after surgery can kill any remaining cancer cells.
There are two types of chemotherapy for bladder cancer:
Intravesical chemotherapy: This treatment is given after TURBT for early stage bladder cancer. Chemotherapy drugs are placed into the bladder through a urethral catheter.
Systemic chemotherapy: For this treatment, chemotherapy is given as pills, through an IV or by injection. Because these drugs can travel through the blood, they can treat cancer that has spread outside the bladder.
Because chemotherapy kills some normal cells along with cancer cells, it can have many side effects. These include nausea, hair loss, mouth sores, changes in bowel habits, easy bleeding or bruising, fatigue and increased risk for infection. Many of these side effects go away after treatment. Your treatment team will help you manage the side effects you experience.
This treatment uses high doses of radiation to kill cancer cells or slow their growth. External beam radiation is the type of radiation treatment used for bladder cancer. It aims the radiation at your cancer from outside your body.
For early stage cancer, radiation may be given after TURBT to kill any remaining cancer cells. For later stage cancer, it may be given before, after or along with other treatments. It may be used to reduce symptoms with advanced bladder cancer.
Like chemotherapy, radiation therapy also kills some normal cells and has side effects. Common side effects include skin changes, nausea, diarrhea, blood in your urine, burning when passing urine, needing to pass urine often, fatigue, easy bleeding or bruising and problems holding urine (incontinence). Many of these side effects go away after treatment. Your treatment team will help you manage the side effects you experience from radiation.
Immunotherapy is a treatment that uses your body’s own defense system — the immune system — to fight your cancer. The immune system recognizes and attacks foreign invaders, like germs. It also has the ability to recognize and attack cancer cells, but it needs help. That's because it may not recognize cancer cells as easily as it identifies germs. Immunotherapy stimulates your immune system.
There are two types of immunotherapy for bladder cancer:
Intravesical BCG: This type of immunotherapy has been used against bladder cancer for a long time. It involves placing a type of bacteria — BCG — into your bladder. The bacteria do not cause an infection, but they may trigger your immune system to become more active against cancer cells. BCG is often used in early stage cancer after TURBT to keep the cancer from coming back. The treatment can be repeated several times.
Immune checkpoint inhibitors: These are new immunotherapy drugs for bladder cancer. The drugs turn off proteins in your immune system that prevent the immune system from attacking your cells. Your immune system becomes more active and may begin recognizing and attacking the cancer cells. The drugs are given through an IV every few weeks. They are used for advanced cancers that come back after chemotherapy.
Side effects of the BCG treatment are usually mild and go away after treatment. They include cold or flu-like symptoms, such as chills, fever and fatigue. You may also experience some burning and blood when passing urine. Side effects of immune checkpoint inhibitors include nausea, fever, rash, infections, diarrhea and constipation. Many of these side effects go away after treatment. Your treatment team will help you manage side effects you experience from immunotherapy.
Many of the newest treatments for bladder cancer are being given in clinical trials. Participants in a clinical trial get either the best standard treatment or a new treatment. These trials are done at research centers and university hospitals experienced in treating cancer.
If you qualify for a clinical trial, you will be treated by cancer teams that are experts in cancer treatment. Your treatment may be free or low-cost. However, new treatments may have unknown risks, and they might not work as well as standard treatments. It's important to discuss the risks and benefits of participating in a clinical trial with your treatment team.