Your Guide to Bladder Cancer Treatment

Your Guide to Bladder Cancer Treatment

Different types of treatment are available for people with bladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. There are several types of standard treatment for bladder cancer:

Surgery  

Surgery is the main treatment for bladder cancer. The type of surgery depends on where the cancer is located. Other treatments may be given in addition to surgery:

Treatment given before surgery is called preoperative therapy or neoadjuvant therapy. Chemotherapy may be given before surgery to shrink the tumor and reduce the amount of tissue that needs to be removed during surgery.

Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. After the doctor removes all the cancer that can be seen, some patients may be given chemotherapy, radiation therapy, immunotherapy, and/or targeted therapy to kill any cancer cells that are left.

The types of surgery done to treat bladder cancer are:

  • 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 cystectomy: Partial cystectomy is surgery to remove part of the bladder. This may be done for people 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, people are able to urinate normally after recovering from this surgery. This is also called segmental cystectomy.
  • Radical cystectomy with urinary diversion: Radical cystectomy is surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle layers or when non-muscle-invasive bladder cancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and can’t be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon performs a procedure called urinary diversion to create 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. 

Immunotherapy helps a person’s immune system fight cancer.

Radiation Therapy  

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Bladder cancer is sometimes treated with external beam radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Radiation therapy may be given alone or with other types of treatment, such as chemotherapy.

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Chemotherapy  

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given alone or with other types of treatment. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Systemic chemotherapy

Systemic chemotherapy for bladder cancer is when chemotherapy drugs are injected into a vein. When given this way, the drugs enter the bloodstream to reach cancer cells throughout the body.

Intravesical chemotherapy

For bladder cancer, chemotherapy may be intravesical, meaning it is put into the bladder through a tube inserted into the urethra. Intravesical treatments flush the bladder with drugs that kill cancer cells that remain after surgery. This lowers the chance of the cancer coming back.

Immunotherapy

Immunotherapy helps a person’s immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs.

Systemic immunotherapy

Systemic immunotherapy drugs used to treat urothelial cancer (a type of bladder cancer) include

  • avelumab
  • nivolumab
  • pembrolizumab

These drugs work in more than one way to kill cancer cells. They are also considered targeted therapy because they target specific changes or substances in cancer cells.

Intravesical immunotherapy

BCG (bacillus Calmette-Guérin) is an intravesical immunotherapy drug used to treat bladder cancer. BCG is given in a solution that is placed directly into the bladder using a catheter (thin tube). Intravesical treatments flush the bladder with drugs that kill cancer cells that remain after surgery. This lowers the chance of the cancer coming back.

Targeted therapy

Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells. Your doctor may suggest biomarker tests to help predict your response to certain targeted therapy drugs.

Clinical Trials

A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for people with cancer. For some, taking part in a clinical trial may be an option.

Follow-Up Testing  

After starting treatment for bladder cancer, follow-up tests may be needed. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. 

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred.

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New types of treatment for bladder cancer are being tested in clinical trials. To learn more about clinical trials, visit cancer.gov/clinicaltrials

Source: National Cancer Institute, cancer.gov (February 2023)

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