Treatment options

Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team. 

Treatment for bladder cancer depends on: 

• the stage of the disease 
• the severity of symptoms  
• your wishes and preferences 
• your general health.  

Superficial bladder cancers (where the cancer is only within the inside lining of the bladder) are usually treated with surgery, immunotherapy or chemotherapy ^[27]. In most cases, invasive bladder cancers (where the cancer has spread to other areas) are treated with surgery, although radiation therapy, immunotherapy and chemotherapy may also be used ^[28].  

Bladder cancer can come back after it has been treated (recur). ^[29] It may come back in the bladder or in other parts of the body ^[30]. 

Surgery 

Surgery to remove the cancer is the main treatment for bladder cancers ^[31][32]. This is usually done using a thin hollow tube passed through the urethra and into the bladder (an operation known as a transurethral resection). The cancer is then burned or removed through the urethra ^[33].  

Advanced cancers may need more than one transurethral resection operations ^[34], or surgery to remove part of the bladder (partial cystectomy) or the whole bladder (radical cystectomy) ^[35]. 

Surgery may also be needed to make a new way for the body to store and pass urine (urinary diversion). ^[36] The urine may be diverted from the kidneys into a bag which sits on the front of the belly through an opening called a stoma. This is called a urostomy. ^[37]

Intravesical therapy  

Intravesical therapy is treatment where the medicine is put right into the bladder rather than by mouth or injection. The medicine is given through a tube (urinary catheter) that is inserted into the bladder through the urethra. 

Intravesical therapy is mainly used for early-stage cancers that are still in the inside lining of the bladder and can be used before surgery to make treatment successful. 

There are two main types of intravesical therapy: immunotherapy and chemotherapy. Intravesical immunotherapy, such as Bacillus Calmette-Guerin (BCG) uses the body’s own immune system to attack bladder cancer cells. 

Intravesical chemotherapy, such as mitomycin or gemcitabine, is used to directly destroy bladder cancer cells.  

Because this treatment is administered locally, most side effects are of local irritation, burning on passing urine and changes in urine colour. 

Radiation therapy 

Radiation therapy uses high-energy X-rays or other types of radiation to stop cancer cells growing, or to destroy existing cancer cells. You cannot feel the radiotherapy and it doesn’t hurt when it is given.  

The type of radiation most often used to treat bladder cancer is called external beam radiation therapy (EBRT) which directs radiation to the affected area from outside the body. 

Before having radiotherapy, your doctor and radiation team will take careful measurements and scans to map the area that needs to be treated. Radiation treatment is usually given on a daily basis, and lasts a few minutes.  

Side effects of radiotherapy depend on the area being treated and can include skin changes, bladder irritation, fatigue, diarrhoea and changes in urination.  

For more information on radiotherapy, see Radiotherapy 

Chemotherapy 

Chemotherapy uses medicines to stop the growth of cancer cells. Treatment may involve injecting a substance into a vein or muscle, or taking pills by mouth. For bladder cancer, chemotherapy substances may be put directly into the bladder through a tube inserted into the urethra ^[38][39] (see Intravesical treatment above). This is used mainly for cancer that hasn’t spread beyond the lining of the bladder, and may be used during transurethral resection surgery ^[40].  

Different chemotherapy options are used to treat different types and stages of bladder cancer ^[41]. Sometimes more than one type of chemotherapy treatment may be used. Chemotherapy can cause side effects which depend on the type and number of chemotherapy agents used.  

Chemotherapy can be given at various times including before surgery (neoadjuvant chemotherapy) to shrink the tumour, or after surgery (adjuvant chemotherapy) to reduce the risk of the cancer coming back. It can be used as a main treatment for cancer that has spread to distant parts of the body to improve symptoms and prolong life. 

For further information regarding chemotherapy, see Chemotherapy. 

Immunotherapy 

Immunotherapy increases the patient’s immune system to help it fight the cancer. Immunotherapy treatment for bladder cancer may involve taking pills by mouth or placing a solution directly into the bladder through a tube inserted into the urethra ^[42] (see intravesical therapy above) 

Immunotherapy can also be given through an injection into the veins. Cancer cells use different proteins, called “checkpoints” to stop the immune system from attacking them. Newer immunotherapies, called immune checkpoint inhibitors can help the immune system to destroy the cancer cells. Some commonly used immunotherapy drugs used in bladder cancer are avelumab and nivolumab. 

For further information regarding immunotherapy, see Immunotherapy. 

Research is ongoing to find new ways to diagnose and treat different types of cancer. Some people may be offered the option of participation in a clinical trial to test new ways of treating bladder cancer.