Virginia Commonwealth University

VCU Massey Cancer Center

Treatment

Specific treatment for bladder cancer will be determined by your physician based on:

  • Your age, overall health and medical history.
  • Extent of the disease.
  • Grade and stage of the cancer.
  • Your tolerance of specific medicines, procedures or therapies.
  • Expectations for the course of the disease.
  • Your opinion or preference.

About 70 percent to 80 percent of individuals with bladder cancer have superficial and noninvasive tumors. Treatment for these tumors is often very effective with an excellent prognosis. About 25 percent of bladder cancers invade deep into the bladder wall and muscle. There is a greater risk for metastasis into other tissues in these cases. Depending on the extent, bladder cancers may be managed with a single therapy or combination of treatments.

Treatment options

  • Surgery– there are several surgical procedures used to treat bladder cancers. Usually, hospitalization and anesthesia are needed. These procedures include:
    • Transurethral resection – the surgeon inserts a cystoscope through the urethra into the bladder. Tissue containing cancer cells can be surgically removed or burned away with an electric current called fulguration.
    • Cystectomy– surgery to remove part or all of the bladder.
      • Segmental cystectomy – removal of a small portion of the bladder that contains the cancerous tissue. This procedure is most effective when there is only a single site of cancer cells in the bladder.
      • Radical cystectomy – removal of the bladder, lymph nodes near the bladder and any nearby organs that contain cancer cells. This procedure is usually used when there are multiple areas of cancerous cells in the bladder and there is metastasis to other sites. When the bladder is removed, a urostomy procedure is performed. This surgical procedure creates another opening for urine to drain. Women who have a radical cystectomy usually have their uterus, ovaries and part of the vagina removed as well. The prostate gland and seminal vesicles are usually removed in men who have a radical cystectomy.
  • Radiation therapy – uses high-energy rays to kill or shrink cancer cells. Internal or external radiation, or both, may be used in the treatment of bladder cancer. With internal radiation, a radiation implant is placed into the bladder for a direct effect on cancer cells. External radiation uses a machine outside the body to direct rays at a broader area. Radiation therapy for bladder cancer may have side effects including nausea, vomiting, diarrhea and urinary discomfort, and may affect sexual function in both men and women.
  • Chemotherapy – uses anti-cancer drugs to kill cancer cells. Chemotherapy may be given internally by placing the drugs directly in the bladder, called intravesical chemotherapy. It also may be given systemically, to affect cancer cells throughout the body. Like other chemotherapy drugs, those used to treat bladder cancer could have side effects that may include hair loss, nausea, vomiting, bruising and fatigue. Drugs used directly in the bladder may cause irritation or bleeding.
  • Biological therapy – uses the body’s own immune system to fight cancer. In one form of this therapy, a solution called bacille Calmette-Guerin is placed in the bladder, where it stimulates the immune system to kill the cancer cells.
  • Clinical trials – clinical trials and research studies are underway to evaluate new therapies. Some of these include photodynamic therapy, which involves the use of light to kill cancer cells, and the use of interferon as an anticancer agent.

The long-term prognosis for individuals with bladder cancer depends on the size of the tumor, lymph node involvement and degree of metastasis (spreading) at the time of diagnosis. There is an increased chance for recurrence of bladder cancer for some individuals. About 55 percent to 80 percent of superficial bladder cancers reoccur within a few years, depending on the type of treatment. However, in most cases, the extent of the reoccurring cancer is no more severe than the previous condition.

What is a urostomy?

A urostomy is a surgical procedure to create a new opening for urine drainage. Usually, a small portion of the small intestine is used to make a tube for urine passage to the outside of the body. The opening of this tube is called a stoma. Urine empties into a small pouch or bag attached over the stoma outside the body. Another type of urostomy procedure creates an internal pouch called a continent reservoir. This pouch, often made from the small intestine, is located inside the abdominal wall. It is connected to the urethra or to a stoma. Individuals with a continent reservoir urostomy learn to drain their urine using a catheter, either through the urethra or the stoma.

Reducing the risk of bladder cancer

While there is no known way to prevent bladder cancer, you can reduce your chances of developing the disease. The American Cancer Society offers the following recommendations:

  • Do not smoke.
  • Avoid occupational exposure to certain chemicals.
  • Drink plenty of liquids to help limit the time that cancer-causing substances present in urine will remain in contact with bladder cells.