Treatments for stage II bladder cancer
The following are treatment options for stage II bladder cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Surgery is the main treatment for stage II bladder cancer. A radical cystectomy is the main type of surgery used.
A radical cystectomy 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 and 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).
Some people may be able to have bladder-sparing surgery. These surgeries are used if there is only one tumour, it is less than 5 cm in size, it isn’t in the floor of the bladder where the ureters enter the bladder and the bladder is working fairly normally.
A partial, or segmental, cystectomy removes the tumour and part of the bladder. It may be used when a single tumour is in a part of the bladder that can easily be removed with clear surgical margins (no cancer cells in the margins of the tissue removed along with the tumour) and there is no cancer in other parts of the bladder. The surgeon will also remove the pelvic lymph nodes because bladder cancer is likely to spread to them.
Transurethral resection (TUR)
A transurethral resection (TUR) 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 is the first step in treating a bladder tumour. It is done to confirm the diagnosis and to find out the extent, or stage, of the tumour in the bladder.
In very rare cases, TUR is used to remove a small stage II tumour that is just starting to grow into the muscle layer of the bladder wall from the inner lining of the bladder. A second TUR is often done to make sure the tumour has not grown deeper into the muscle wall.
A TUR may also be used to remove as much of the tumour as possible. It is followed by radiation therapy and chemotherapy. This is called trimodal therapy because 3 treatments are given.
Chemotherapy is often used to treat stage II 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 II bladder cancer are:
- GemCIS, or GC – gemcitabine (Gemzar) and cisplatin (Platinol AQ)
- 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).
External beam radiation therapy may be used to treat stage II bladder cancer. It may be given as well as chemotherapy and after the tumour has been completely removed by a TUR. When all 3 treatments are used (radiation therapy, chemotherapy and TUR), it is called trimodal therapy. This treatment is used in some people instead of surgery if there is only one tumour, the tumour is smaller than 5 cm, the ureters aren’t blocked and the bladder is working normally. Radiation therapy can also be given to people who do not want, or cannot have, surgery.
Radiation works better when it is given as well as chemotherapy, but some people will not cope well with this combined treatment. For these people, radiation is given alone. The chemotherapy drugs that are commonly given during chemoradiation are:
- 5-fluorouracil (Adrucil, 5-FU) and mitomycin (Mutamycin)
You may be asked if you want to join a clinical trial for bladder cancer. Find out more about clinical trials.
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