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Treatments for bladder cancer
If you have bladder cancer, your healthcare team will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for bladder cancer, your healthcare team will consider:
- stage of the tumour
- grade of the tumour
- location of the tumour
- your overall health
You may be offered the following treatments for bladder cancer.
Most people will have surgery to treat bladder cancer. The type of surgery you have will depend on the type of tumour and the stage of the cancer.
Transurethral resection (TUR) is most often used to remove tumours that are only in the lining of the bladder and have not grown into the muscle layer of the bladder wall (called non-muscle-invasive bladder cancer). It is also the first step in diagnosing and treating more advanced tumours.
Partial, or segmental, cystectomy removes the tumour and part of the bladder.
Radical cystectomy removes all of the bladder along with the surrounding fatty tissue and nearby lymph nodes. Some reproductive organs may also be removed.
Urinary diversion to create a urinary path is needed after the bladder is removed with a radical cystectomy.
Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells. Biological therapy uses natural or artificial substances that act like (mimic) or block natural cell responses to kill, control or change the behaviour of cancer cells.
Immunotherapy is most often used to treat tumours that are only in the lining of the bladder but have a higher risk for growing into deeper layers (especially high-grade and T1 tumours).
The immunotherapy treatment used most often is the vaccine bacillus Calmette-Guérin (BCG). BCG is passed into the bladder through a urinary catheter, or tube (called intravesical immunotherapy).
Immunotherapy may be offered for locally advanced or metastatic bladder cancer as a second-line therapy if the cancer is still growing during or just after finishing chemotherapy with cisplatin or if the cancer recurs within 12 months after finishing chemotherapy with cisplatin. The immunotherapy drug that is used for advanced bladder cancer is pembrolizumab (Keytruda).
Intravesical chemotherapy or systemic chemotherapy may be used to treat bladder cancer.
During intravesical chemotherapy, the drugs are placed into the bladder through a urinary catheter. Intravesical chemotherapy may be given instead of BCG or if the bladder cancer doesn’t respond to BCG. Mitomycin (Mutamycin) is the drug most often used in intravesical chemotherapy. A dose of mitomycin is usually put into the bladder after surgery to remove the bladder tumour. Intravesical chemotherapy with mitomycin reduces the risk of bladder cancer recurring (coming back) in people with tumours that are only in the lining of the bladder and have not grown into the muscle layer of the bladder wall (called non-muscle-invasive bladder cancer).
During systemic chemotherapy, the drugs are given through a needle into a vein (intravenously) and circulate throughout the body. Systemic chemotherapy may be a treatment option for bladder cancer that has spread to other tissues near the bladder (called locally advanced cancer) and bladder cancer that has spread to other parts of the body (called metastatic cancer). Chemotherapy is recommended before a radical cystectomy (called neoadjuvant chemotherapy) for many people with bladder cancer that has grown into the muscle layer of the bladder wall. It is also often given after a radical cystectomy (called adjuvant chemotherapy) to people with high-risk features such as cancer that has spread to lymph nodes.
External beam radiation therapy is the type of radiation treatment that is most often used to treat bladder cancer.
Some people with cancer that has grown into the muscle layer of the bladder wall (called muscle-invasive bladder cancer) will have a transurethral resection (TUR) to completely remove all the cancer that the surgeon can see. This surgery is followed by both radiation therapy and chemotherapy.
Radiation therapy may be the main treatment for people who can’t have surgery. It may also be given to relieve symptoms caused by advanced bladder cancer (called palliative radiation therapy).
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 3 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to people with bladder cancer. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
Treatment given for a condition or disease (such as cancer) when the first-line therapy (the first or standard treatment) does not work or stops working.
Also called secondary therapy or secondary treatment.
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