Bladder cancer is often treated by a urologist (a urinary tract specialist) and an oncologist (a cancer specialist). Your cancer care team will consider several factors when suggesting a treatment plan for you, including:

• Cancer stage and grade, which refers to how advanced and aggressive it is
• Your treatment goals, such as curing the cancer or managing symptoms
• Your age and overall health, which influence treatment safety and outcomes
• Your personal preferences, which guide decisions about balancing treatment benefits and side effects

This article will help you understand the bladder cancer treatment options so you can make informed decisions about your care.

1. Surgery

Surgery is usually the main treatment for early-stage bladder cancer. There are several types of bladder cancer surgery. The type of surgery you have depends on your cancer stage, the location of the tumor, and your preferences.

Transurethral Resection of Bladder Tumor

Transurethral resection of bladder tumor (TURBT) is a surgical procedure used both to diagnose bladder cancer and treat it. This procedure is similar to a cystoscopy, where a long, thin tube with a camera is inserted into the bladder through the urethra (the end of the urinary tract that carries urine out of the body). In a TURBT, the long thin tube is called a resectoscope. It has a wire loop that’s used to cut off any abnormal tissue. This tissue can be sent to a laboratory to determine if the cancer has affected the muscle layer of the bladder and help with the staging. The remaining cancer cells can be burned off (a process called fulguration) or destroyed with a laser on the resectoscope. You’ll get medicines to put you to sleep or numb you during this procedure.

TURBT may be the only type of surgery needed if you have non-muscle invasive bladder cancer (NMIBC). However, you may need a second TURBT a few months after the first to make sure all of the cancer is removed. A more extensive TURBT procedure may be combined with chemotherapy and radiation therapy to treat people with stage 2 bladder cancer who don’t want to have surgery to remove their bladder. This is called bladder-preserving trimodality therapy.

If you have stage 2, 3, or 4 bladder cancer, you will probably have a TURBT as one of your first treatments. (Stages for bladder cancer are also generally rendered with Roman numerals, e.g., stage III instead of stage 3.) However, in this case, it’s used to help stage your cancer instead of treating it.

Cystectomy

A cystectomy is a bladder removal surgery. It’s used to treat people with muscle-invasive bladder cancer (MIBC) or in some cases of NMIBC, but with very high-risk features.

Some people with stage 2 bladder cancer with tumors only in one part of the bladder may be able to have a partial cystectomy. In this procedure, only part of the bladder is removed before it can be stitched up. Having a partial cystectomy means that reconstructive surgery isn’t needed because the bladder stays in the body. However, this type of surgery isn’t used often because there’s a risk that cancer could still be in other parts of the bladder.

If bladder cancer is found in more than one part of the bladder or if it’s large, your cancer care team may recommend a radical cystectomy. In this procedure, a surgeon removes your entire bladder, lymph nodes, and parts of the reproductive system. In men, the prostate and seminal vesicles (semen-producing glands) are removed, according to the American Cancer Society, and in women, the uterus, ovaries, fallopian tubes, cervix, and part of the vagina are removed.

Hospital stays typically range from five to 10 days depending on the type of cystectomy performed and a person’s recovery progress.

Reconstructive Surgery

Reconstructive surgery is necessary for people who have a radical cystectomy. Without a bladder, you’ll need a new way for urine to leave your body. Some types of reconstructive surgery direct urine to a bag attached to the outside of your body. Other types of surgery create a new pouch to store urine on the inside of your body.

If the bladder can’t be removed because the cancer is too large or has spread, reconstructive surgery may be necessary to treat complications like urine flow blockage.

2. Intravesical Therapy

Intravesical therapy is a treatment where a liquid drug is put directly into your bladder through a catheter (tube). The drugs given directly into the bladder only touch the inner lining of the bladder. This means there isn’t an effect on cancer that’s spread to deeper layers of the bladder or other parts of the body. However, this type of treatment can help reduce side effects because the drugs don’t enter the bloodstream.

Intravesical therapy is often used after a TURBT for people with early-stage bladder cancer that hasn’t spread to the muscle layer of the bladder or other parts of the body. You may get a single dose of intravesical therapy within 24 hours of getting a TURBT. If you have NMIBC with a low risk of spreading, this may be the only intravesical therapy you get. If you have NMIBC with a high risk of spreading, you may get more intravesical therapy that begins a few weeks later. Intravesical therapy is usually given weekly for six weeks to three years.

There are two types of drugs used in intravesical therapy — chemotherapy drugs and immunotherapy drugs. Chemotherapy (chemo) drugs kill growing cancer cells. Gemcitabine (Gemzar) and mitomycin (Mutamycin) are commonly used chemo drugs for intravesical chemotherapy.

Immunotherapy drugs help your own immune system attack and kill cancer cells. Commonly used intravesical immunotherapy drugs include:

• Bacillus Calmette-Guérin (Tice BCG)
• Nadofaragene firadenovec-vncg (Adstiladrin)
• Nogapendekin alfa inbakicept-pmln (Anktiva)

3. Systemic Chemotherapy

Systemic chemotherapy is when chemo enters your bloodstream and travels around your body to kill cancer cells. Systemic chemotherapy is given in a few different ways to treat bladder cancer:

• Neoadjuvant therapy — Chemo that’s given before surgery to make it easier to remove and lower the risk of recurrence (cancer that comes back after treatment)
• Adjuvant therapy — Chemo that is given after surgery or radiation therapy to kill remaining cancer cells and lower the risk of recurrence
• Chemoradiation — Chemo that’s given together with radiation therapy to help it work better

Chemotherapy may also be the main treatment for people with advanced or metastatic bladder cancer (cancer that has spread) that can’t be removed with surgery.

In most cases, a combination of two or more drugs may be necessary. Commonly used chemo drugs include:

• Carboplatin
• Cisplatin
• Doxorubicin
• Gemcitabine
• Methotrexate (Trexall)
• Paclitaxel
• Vinblastine

4. Radiation Therapy

Radiation therapy is a treatment that uses high-energy X-rays or radiation to kill cancer cells. This treatment may be used to treat bladder cancer in several ways:

• After a TURBT in early-stage bladder cancer
• In people who can’t have or don’t want surgery
• As the main treatment for people with advanced bladder cancer
• As palliative therapy to relieve symptoms of bladder cancer

5. Immunotherapy

Immunotherapy can also be given as a systemic treatment to help your immune system find and destroy cancer cells. Immune checkpoint inhibitors, like nivolumab (Opdivo), pembrolizumab (Keytruda), and avelumab (Bavencio), are a type of immunotherapy used to treat bladder cancer. These drugs work by blocking proteins cancer cells use to avoid being recognized by the immune system.

Pembrolizumab can also be combined with laboratory-made antibodies (immune proteins), called antibody-drug conjugates (ADCs). Enfortumab vedotin (Padcev) is an ADC used for bladder cancer. ADCs can be considered a type of immunotherapy or targeted therapy.

6. Targeted Therapy

Targeted therapies are drugs that target a specific protein or substance found in cancer cells. Erdafitinib (Balversa) is a fibroblast growth factor receptor (FGFR) inhibitor. FGFR is a gene that provides information on how to make a protein important for cell growth. Some types of bladder cancer have a gene mutation (change) in the FGFR gene that helps them grow. Erdafitinib can help treat people with advanced bladder cancer that isn’t responding to other treatments.

7. Clinical Trials

Clinical trials are studies that help researchers discover whether new treatments are safe and effective. Your cancer care team may recommend joining a clinical trial if you have advanced or recurrent bladder cancer. Being part of a clinical trial may give you access to new treatments that aren’t yet available. When you participate in a clinical trial, you’re also helping to advance cancer research.

Talk to your cancer care team to see if you qualify for a clinical trial in your area. You can also search for a clinical trial on the Bladder Cancer Advocacy Network website.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Do you or a loved one have bladder cancer? What treatment or treatment types have you undergone? Share your experience in the comments below, or start a conversation by posting on your Activities page.