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Treatments and drugs
By Mayo Clinic staffYour treatment options for bladder cancer depend on a number of factors, including the type and stage of the cancer, your overall health and your treatment preferences. Discuss your options with your doctor to determine what treatments are best for you.
Surgical procedures
The types of surgical procedures available to you may be based on factors such as the stage of your bladder cancer, your overall health and your preferences.
Surgery for early-stage bladder cancer
If your cancer is very small and hasn't invaded the wall of your bladder, your doctor may recommend:
- Surgery to remove the tumor. Transurethral resection of bladder tumor (TURBT) is often used to remove bladder cancers that are confined to the inner layers of the bladder. During TURBT, your doctor passes a small wire loop through your urethra and into your bladder. The loop is used to burn away cancer cells with an electric current (fulguration). In some cases, a high-energy laser may be used instead of electric current. TURBT may cause painful or bloody urination for a few days following the procedure.
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Surgery to remove the tumor and a small portion of the bladder. During segmental cystectomy, sometimes called partial cystectomy, the surgeon removes only the portion of the bladder that contains cancer cells. Segmental cystectomy may be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function.
Surgery carries a risk of bleeding and infection. You may experience more frequent urination after segmental cystectomy, since the operation reduces the size of your bladder. Over time this may improve, though in some people it's permanent.
Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider:
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Surgery to remove the entire bladder. A radical cystectomy is an operation to remove the entire bladder, as well as surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.
Cystectomy carries a risk of infection and bleeding. In men, removal of the prostate and seminal vesicles will cause infertility. But in most cases your surgeon can attempt to spare the nerves necessary for an erection. In women, removal of the ovaries causes infertility and premature menopause in women who haven't experienced menopause prior to this surgery.
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Surgery to create a new way for urine to leave your body. Immediately after your radical cystectomy, your surgeon works to create a new way for you to expel urine. Several options exist. Which option is best for you depends on your cancer, your health and your preferences. Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your kidneys to the outside of your body, where your urine drains into a pouch (urostomy bag) you wear on your abdomen.
In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day.
In select cases, your surgeon may create a bladder-like reservoir out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your new bladder.
Biological therapy (immunotherapy)
Biological therapy, sometimes called immunotherapy, works by signaling your body's immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy).
Biological therapy drugs used to treat bladder cancer include:
- An immune-stimulating bacterium. Bacille Calmette-Guerin (BCG) is a bacterium used in tuberculosis vaccines. BCG can cause bladder irritation and blood in your urine. Some people feel as if they have the flu after treatment with BCG.
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A synthetic version of an immune system protein. Interferon is a protein that your immune system makes to help your body fight infections. A synthetic version of interferon, called interferon alfa, may be used to treat bladder cancer. Interferon alfa is sometimes used in combination with BCG. Interferon alfa can cause flu-like symptoms.
Biological therapy can be administered after TURBT to reduce the risk that cancer will recur.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination. Drugs can be given through a vein in your arm (intravenously), or they can be administered directly to your bladder by passing a tube through your urethra (intravesical therapy).
Chemotherapy may be used to kill cancer cells that might remain after an operation. It may also be used before surgery. In this case, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Chemotherapy is sometimes combined with radiation therapy.
Radiation therapy
Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy can come from a machine outside your body (external beam radiation) or it can come from a device placed inside your bladder (brachytherapy).
Radiation therapy may be used before surgery to shrink a tumor so that it can more easily be removed. Radiation therapy can also be used after surgery to kill cancer cells that might remain. Radiation therapy is sometimes combined with chemotherapy.
- What you need to know about bladder cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/bladder/allpages. Accessed Feb. 17, 2010.
- Bladder cancer treatment (PDQ): Health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional/allpages/print. Accessed Feb. 17, 2010.
- Smith DC, et al. Carcinoma of the bladder. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008:1635.
- Bladder and other urothelial cancers screening (PDQ): Health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/screening/bladder/healthprofessional/allpages/print. Accessed Feb. 17, 2010.
- Bladder cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf. Accessed Feb. 17, 2010.
- Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1 and Tis): 2007 update. Linthicum, Md.: American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bc. Accessed Feb. 23, 2010.
- Messing EM. Urothelial tumors of the bladder. In: Wein AJ, et al. Campbell-Walsh Urology. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/185270227-3/0/1445/0.html. Accessed Feb. 23, 2010.
- La Rochelle J, et al. Chemoprevention of bladder cancer. BJU International. 2008;102:1274.
- Boehrn K, et al. Green tea (Camellia sinensis) for the prevention of cancer. Cochrane Database of Systematic Reviews. 2009:CD005004.
- Busby JE, et al. Chemoprevention for bladder cancer. The Journal of Urology. 2006;176:1914.
- Castle EP (expert opinion). Mayo Clinic, Scottsdale/Phoenix, Ariz. March 7, 2010.
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