Bladder cancer

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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 health and specific information about the cancer. When deciding which treatments to offer for bladder cancer, your healthcare team will consider:

You will be offered one or more of the following treatments for bladder cancer.

Surgery

Surgery is a main treatment for most bladder cancers. It may be done first or after other treatments such as chemotherapy. Depending on the stage of the cancer, you may have one or more of the following types of surgery.

A transurethral resection of bladder tumour (TURBT) removes tumours from the bladder through the urethra. It is the most common way to diagnose bladder cancer. A TURBT is also used to treat early stages of bladder cancer (including non-invasive and non-muscle-invasive bladder cancers).

A cystectomy removes all or part of the bladder. It is most commonly done for bladder cancer that has grown into the muscle layer of the bladder wall (called muscle-invasive bladder cancer).

A pelvic lymph node dissection (PLND) removes lymph nodes from the pelvis. It is usually done during a cystectomy.

A urinary diversion is reconstructive (rebuilding) surgery that makes a new way for urine (pee) to leave the body. It is done after the whole bladder is removed (called a radical cystectomy).

Immunotherapy

To treat early stages of bladder cancer, immunotherapy may be placed directly in the bladder (called intravesical immunotherapy) after a TURBT. The immunotherapy drug most commonly used is bacillus Calmette-Guérin (BCG).

To treat advanced or metastatic bladder cancer, immunotherapy may be used when chemotherapy doesn’t work. An immunotherapy drug called an immune checkpoint inhibitor is used.

Chemotherapy

To treat early stages of bladder cancer, chemotherapy may be placed directly in the bladder (called intravesical chemotherapy) after a TURBT. It can be used instead of BCG. The chemotherapy drug most commonly used is mitomycin (Mutamycin).

To treat later stages of bladder cancer, systemic chemotherapy is usually given before or after a radical cystectomy. In some cases, systemic chemotherapy may be combined with radiation therapy (called chemoradiation) and given after a TURBT. It is also used to help improve survival and the quality of life for people with metastatic bladder cancer. A combination of chemotherapy drugs that includes cisplatin is most commonly used.

Radiation therapy

External radiation therapy is sometimes used to treat bladder cancer. It may be used as a part of chemoradiation to treat cancer that has grown into the muscle layer of the bladder wall. The chemoradiation is given after surgery with a TURBT so the bladder doesn’t have to be removed (called a bladder-preserving approach). External radiation therapy may also be used alone if surgery can’t be done (the cancer is unresectable) or to control bleeding from the bladder.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Follow-up care

Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 2 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.

Clinical trials

Talk to your doctor about clinical trials open to people with bladder cancer in Canada. Clinical trials look at new 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.

stage

A description of the extent of cancer in the body, including the size of the tumour, whether there are cancer cells in the lymph nodes and whether the disease has spread from its original site to other parts of the body.

Stages are based on specific criteria for each type of cancer.

The process of determining the extent of cancer in the body based on exams and tests is called staging.

grade

A description of a tumour that includes how different the cancer cells look from normal cells (differentiation), how quickly the cancer cells are growing and dividing, and how likely they are to spread.

Grades are based on different grading systems that are used for specific cancers. Some types of cancer do not have a specific grading system.

The process of examining and classifying tumours based on how cancer cells look and behave under the microscope is called grading.

performance status

The measure of how well a person is able to perform ordinary tasks and carry out daily activities.

Examples of scales used to evaluate performance status include the Eastern Cooperative Oncology Group (ECOG), World Health Organization (WHO) and the Karnofsky performance status scale.

systemic therapy

Treatment that travels through the bloodstream to reach cells all over the body.

Systemic therapy may be given by injection into a vein or muscle, or by mouth.

Also called systemic treatment.

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