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Treatments for stage III bladder cancer
The following are treatment options for stage III 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 most people with stage III 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 is often used to treat stage III 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 III 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 III 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:
- 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 III 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.
You may be asked if you want to join a clinical trial for bladder cancer. Find out more about clinical trials.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.