Bladder cancer

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Treatments for stage 3 bladder cancer

The following are treatment options for stage 3 bladder cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery

Surgery is the main treatment for most people with stage 3 bladder cancer. The type of surgery is a radical cystectomy. This surgery removes all of the bladder along with surrounding fatty tissue and nearby lymph nodes. Some reproductive organs may also be removed. In men, the prostate may be removed. In women, the ovaries, the uterus or part of the vagina may be removed.

The surgeon will also remove the pelvic lymph nodes because bladder cancer is likely to spread to them. After removing the bladder, the surgeon creates a new passage for the urine (called a urinary diversion).

Chemotherapy

Chemotherapy is often used to treat stage 3 bladder cancer. It may be given before surgery (called neoadjuvant chemotherapy) or after surgery (called adjuvant chemotherapy). Chemotherapy may also be given with radiation therapy (called chemoradiation) as an alternative to surgery.

The most common chemotherapy drug combinations used for stage 3 bladder cancer are:

  • GemCIS, or GC – gemcitabine (Gemzar) and cisplatin
  • MVAC – methotrexate, vinblastine (Velbe), doxorubicin (Adriamycin) and cisplatin
  • CMV – cisplatin, methotrexate and vinblastine

Another drug combination that is sometimes used is cyclophosphamide (Cytoxan, Procytox) and paclitaxel (Taxol).

Radiation therapy

External beam radiation therapy may be used to treat stage 3 bladder cancer. It may be given to people who do not want, or cannot have, surgery. Radiation works better when it is given along with chemotherapy, but some people cannot cope well with the side effects of chemotherapy due to other medical conditions or their age. For these people, radiation is given alone. Common chemotherapy drugs given with radiation are:

  • cisplatin
  • 5-fluorouracil (Adrucil, 5-FU) and mitomycin (Mutamycin)

Radiation therapy may also be given along with chemotherapy after the tumour has been completely removed by a transurethral resection, or TUR. This is called trimodal therapy because 3 treatments are given.

A TUR would not be offered alone to treat stage 3 bladder cancer. It uses a special instrument passed through a cystoscope to remove the tumour and a margin of healthy tissue around it. The surgeon then burns the area from where the tumour was removed with a high-energy electric current (called fulguration) or a laser. This procedure seals off blood vessels and destroys any remaining cancer.

A TUR may be used as part of trimodal therapy with radiation and chemotherapy as an alternative to bladder surgery and lymph node removal for some people who have only one tumour less than 5 cm, no blockage of the ureters, and normal bladder capacity and function.

Immunotherapy

Immunotherapy may be offered for stage 3 bladder cancer as a second-line therapy if the cancer is still growing during or just after finishing chemotherapy with cisplatin.

The immunotherapy drug that may be used is pembrolizumab (Keytruda).

Clinical trials

You may be asked if you want to join a clinical trial for bladder cancer. Find out more about clinical trials.

second-line therapy

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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