Treatment Options and Medication
The treatment options for bladder cancer depend on a number of factors, such as the type and stage of the cancer, your general health condition, and your treatment preferences. Discuss your options with your doctor to determine the form of therapy that is most suitable for you.
Treatment Options for Early-Stage/Stage I Bladder Cancer
If your cancer is still very small and has not yet invaded the muscle wall of your bladder, your doctor may suggest the following treatment options:
- Surgical removal of the tumor through the urethra
This refers to the transurethral resection of bladder tissue (TURBT), mentioned above, which is commonly used to remove bladder cancer limited to the inner lining of the bladder. Using a small wire loop inserted into the bladder through a cystoscope, your doctor can remove the tumor. In some cases, a laser may be used instead of electric current. - Surgical removal of the tumor and a small part of the bladder
In a procedure called segmental or partial cystectomy, the surgeon removes only the part of the bladder affected by cancer. This is rarely performed and is only an option when the cancer is clearly limited to one area of the bladder that can be removed without harming the rest of the organ. - Biological therapy (immunotherapy)
Biological therapy, also called immunotherapy, aims to help the body’s own immune system fight existing cancer cells. It is used after a TURBT. In the case of bladder cancer, it is typically administered directly into the bladder through the urethra (intravesical therapy). One form of immunotherapy involves instilling the bladder with a bacterium called Bacillus Calmette-Guérin (BCG), which is also used in tuberculosis vaccines. Another commonly used substance is a synthetic version of interferon, a protein that helps your immune system fight infections. After biological therapy, the bladder may be irritated for a few days, and flu-like symptoms are not uncommon.
Surgical Procedures for Muscle-Invasive Bladder Cancer/From Stage II Onwards
If your bladder cancer has already advanced into the deeper layers of the bladder wall, the following surgical procedures may be considered:
- Surgical removal of the entire bladder
This procedure, known as a radical cystectomy, involves the complete removal of the bladder and nearby lymph nodes. In men, the prostate and seminal vesicles are also removed during the operation. In women, a radical cystectomy may include removal of the uterus, ovaries, and parts of the vagina. Radical cystectomies are increasingly performed using robotic-assisted surgery. This means the surgeon operates a robotic system via a control console, allowing for precise movement of the robotic arms. General risks of a cystectomy include wound infection and bleeding. In men, the removal of the prostate and seminal vesicles can result in erectile dysfunction. In some cases, the surgeon may be able to spare the nerves needed for an erection. In women, removal of the ovaries leads to infertility and early menopause. - Surgical procedure to create a new form of urinary diversion
Immediately following a radical cystectomy, your surgeon will create a new way for urine to leave your body. There are several options available, and the most suitable one depends on your condition and preferences. One commonly used method connects the ureters to a segment of small intestine that leads to an opening in the abdominal wall (ileal conduit). This allows urine to drain from the kidneys through the ureters and out of the body into a bag (stoma bag) attached to the skin. Another option involves creating a small urine reservoir inside the abdomen from a section of bowel (catheterizable umbilical pouch). Urine can then be drained several times a day using a catheter through a small, cosmetically discreet opening at the belly button. In selected cases, a bladder-like reservoir, called a neobladder, is created—usually from segments of small intestine. It is connected to the ureters in place of the removed bladder and allows for urination in the normal way. However, the use of a catheter to completely empty the neobladder may still be required.
Chemotherapy
In chemotherapy, cancer cells are destroyed with the help of medication. In bladder cancer, a combination of two or more different chemotherapy drugs is usually used. These can be administered either through a vein in the arm (intravenously) or directly into the bladder through the urethra (intravesical chemotherapy).
Chemotherapy can also be used after surgery to kill any remaining cancer cells. It can also be given before surgery, with the hope of shrinking the tumor enough to allow for a less invasive procedure. In very rare cases, chemotherapy is combined with radiation therapy, especially when surgery is not possible.
Immunotherapy
In immunotherapy, the body’s own immune system is activated by medication so that it can specifically recognize and destroy cancer cells. The medication is administered through a vein in the arm (intravenously) every two to three weeks, and an effect usually appears only after six to eight weeks of treatment.
Immunotherapy is sometimes recommended after the complete removal of the bladder, especially if the cancer has spread beyond the bladder or into the lymph nodes. It can also be given in advanced cases after chemotherapy.
In general, immunotherapy causes far fewer side effects than chemotherapy and can be administered over many months or even years. If side effects occur (when the immune system attacks healthy organs instead of only cancer cells), treatment can be paused, and the side effects are usually well managed with corticosteroi
Radiation Therapy
In radiation therapy, high-energy radioactive beams are used to destroy cancer cells. The type of radiation therapy used for bladder cancer is usually delivered by a machine that moves around your body, allowing it to target the cancer precisely.
Radiation therapy can also be used after surgery to kill any remaining cancer cells. In very rare cases, radiation therapy is combined with chemotherapy, especially when surgery is not possible. However, this approach is generally considered one of the last treatment options.
Follow-Up Care
Bladder cancer has a high risk of recurrence. For this reason, even after successful treatment, bladder cancer survivors must undergo regular follow-up examinations for several years.
Which tests are needed and how often they should be done depends—among other factors—mainly on the type of bladder cancer and the treatment you received. Ask your doctor for a personalized follow-up care plan. Normally, your doctor will recommend an examination of the urethra and bladder (cystoscopy), which should be repeated every three to six months during the first few years after bladder cancer treatment. Later on, one cystoscopy per year is usually sufficient.
Depending on your specific situation, your doctor may also recommend additional tests at different intervals. Patients with aggressive cancer are generally advised to have more frequent follow-up appointments, while those with less aggressive cancer may need them less often.