Comparing Bladder Cancer Treatment Options
Treatments depend on stage and whether the cancer affects the muscle
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Medically reviewed by Jamin Brahmbhatt, MD
Getting a diagnosis of bladder cancer can be overwhelming. You probably wonder if it is curable. Luckily, some bladder cancer is curable, especially when found in the early stages.
Even if the cancer isn’t curable, treatments can prolong your life expectancy and quality of life. Bladder cancer treatment options include surgical removal, immunotherapy, chemotherapy, and radiation. Treatments are highly individualized, so talk with your treatment team about all your options before choosing the one that’s right for you.
Continue reading to learn more about the latest treatment for bladder cancer, including bladder cancer chemotherapy, medication, and more.
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Factors Influencing Success of Bladder Cancer Treatment
There are lots of factors that impact the best bladder cancer treatment for you. The best treatment will depend on:
Your age and overall health
Your goals (whether that’s getting a cure or minimizing symptoms)
Potential side effects from treatments
It never hurts to get a second opinion before you begin treatment. This isn’t rude or disrespectful to the healthcare provider. It’s just a way to advocate for your health and ensure you have all the possible information before deciding on a treatment plan. In addition, ask your healthcare providers whether there are clinical trials that you qualify for. These might impact your treatment plan.
Bladder Cancer Treatment Plan: A Look at the Options
Your healthcare provider will tell you whether your bladder cancer is non-muscle-bladder cancer, which means the cancer cells are only in the lining of the bladder. This type of bladder cancer is curable.
Muscle-invasive cancer, in which the cancer cells are found in the muscle of the bladder, is not considered curable, but some treatments minimize your symptoms and help you continue to live for years. Here are the most common treatments for bladder cancer.
Transurethral Resection of Bladder Tumor (TURBT) Surgery
A transurethral resection of bladder tumor (TURBT) is often the first step for people with bladder cancer. In fact, you might have a TURBT to confirm the diagnosis of bladder cancer. This is an outpatient procedure, meaning you will likely go home after the TURBT is complete.
During this procedure, a healthcare provider will insert a scope into your urethra. You will either be under general anesthesia (asleep) or local anesthesia, which means you’ll be awake but shouldn’t feel any pain. Once the scope reaches your bladder, your surgeon will remove any suspected cancerous cells.
Some people will have more than one TURBT. Your healthcare provider might also suggest immunotherapy before your TURBT. You may have a TURBT to diagnose bladder cancer and another to remove more cancerous cells after the diagnosis is confirmed. In some cases, multiple cuts may be necessary to remove the tumor without fully removing the bladder.
A TURBT is considered very safe, but there are some risks, including an increased risk for a urinary tract infection (UTI), an overactive bladder, or, in rare cases, a perforated bladder. You might also experience pain or discomfort when urinating for a few days after the procedure.
Chemotherapy
Most people with bladder cancer will need chemotherapy, although not everyone will. Two types of chemotherapy are used to treat bladder cancer: Intravesical and systemic. These are usually used alongside other treatments, including radiation and surgery.
Intravesical chemotherapy is a way of putting chemotherapy drugs directly into the bladder using a catheter. It’s usually used for people who only have non-muscle-bladder cancer.
You'll likely need systemic chemotherapy if you have stage 2 or higher bladder cancer. That means you’ll get an intravenous (IV) injection or take a pill that contains chemotherapy drugs. You’ll experience the side effects of chemotherapy, including flu-like symptoms, fatigue, and nausea. The specific side effects will depend on the type of chemo drug your healthcare provider uses, so be sure to ask them about what side effects you can expect.
Immunotherapy
Immunotherapy is a type of cancer treatment that uses your body’s own immune system to fight cancer cells. It can be used in early stages or later stages. The drugs used for immunotherapy and the way that they’re delivered will change based on your cancer stage.
If you have non-muscle-bladder cancer, your healthcare provider might recommend intravesical immunotherapy. With this type of therapy, immunotherapy drugs are inserted directly into your bladder to fight cancer cells.
For more advanced bladder cancer, healthcare providers use infusions of immune checkpoint inhibitors. These immunotherapy drugs are given by an infusion (blood injection) every two to six weeks.
The side effects of immunotherapy include skin irritations like sensitivity to light or blistering. You might also have flu-like symptoms, fatigue, muscle aches, inflammation, and more.
Radiation
Radiation therapy treatment is used alongside chemotherapy for patients with muscle-invasive bladder cancer. It’s also used for people who can’t have chemotherapy or surgery. Before starting radiation, you’ll need computed tomography (CT) scans or other imaging to help healthcare providers find the best angle to target your cancer. Then, you’ll come in for frequent radiation treatments: usually five times a week for many weeks.
Radiation doesn’t hurt but can lead to side effects like skin changes including pain, fatigue, chronic blood in the urine, or overactive bladder symptoms. Talk to your healthcare provider about what to expect in your specific case.
Targeted Drugs
There are at least four medications for treating bladder cancer. These medicines, called targeted drug therapy, slow or stop the growth of cancer. Your healthcare provider will test your cancer cells to see if the type of cancer you have will respond to any of these medications.
The side effects of targeted drug therapy depend on which medication you’re on. Have an honest conversation with your healthcare provider about the benefits and drawbacks of each medication, as well as what side effects you can expect.
Cystectomy
A cystectomy is a surgery to remove all or part of the bladder. Usually, this surgery is done after you’ve already had chemotherapy. Typically it’s for people who have stage 4 bladder cancer or higher.
A partial cystectomy removes a piece of the bladder, usually the muscle wall containing cancer and the nearby lymph nodes. Only a small portion of patients can get a partial cystectomy.
Getting a radical cystectomy is more common. With it, the entire bladder, the surrounding lymph nodes, and some nearby organs where the cancer might have spread are removed. Cisgender men have their prostate and seminal vesicles removed too. Cisgender women have their ovaries, fallopian tubes, uterus, cervix, and a small part of the vagina removed. After a cystectomy, you’ll need reconstructive surgery so that your body has a new way to store and expel urine.
A cystectomy is a major surgery that will impact how you urinate, as well as your sexual and reproductive health. Talk to your healthcare provider about the possible side effects and what you can expect after the cystectomy.
Self-Care During Bladder Cancer Treatment
Undergoing bladder cancer treatment can be physically and emotionally draining. During cancer treatment, try to make time to do things that make you feel better. This can help you keep a positive attitude during cancer treatment.
Self-care is very personal. It might mean learning to cook healthy meals to support your body while it heals, or learning about how chemo might impact your sex life. You might find joy in sitting outside with a good book, or talking with a therapist about your feelings. The key is finding a self-care routine that works for you, and making time for it.
Advanced Bladder Cancer Treatment: Patient Support
Living with bladder cancer isn’t easy, especially with more advanced bladder cancer. But there are specific supports meant to help patients live their best lives while undergoing treatment for bladder cancer. Consider checking out these resources:
Palliative care, a type of care that helps people with serious illness improve their quality of life
The Bladder Cancer Advocacy Network, a nonprofit that provides support groups and other information for patients and their families
Support groups, counseling and resources available through your hospital
Where to Get Bladder Cancer Treatment
Most major hospitals treat bladder cancer. Chances are, if you have a recent diagnosis or suspected bladder cancer, you’re already connected with a medical system. Talk to your existing healthcare providers about where they recommend that you go for care. But don’t be afraid to switch providers or seek a second opinion.
When you’re considering where to get bladder cancer treatment, consider the following:
Is the hospital experienced at treating bladder cancer?
Do they have the treatments you’d like available?
What are the wraparound services, including counseling and support groups?
How close is it to your home and/or support network?
Does the hospital accept your insurance?
Summary
There are many treatment options available for bladder cancer. Many people start treatment with a TURBT surgery and chemotherapy. Others might need radiation, immunotherapy, targeted drugs, or even bladder-removal surgery. Treatment is highly personalized, so always talk with your healthcare provider about your concerns. Ask not only how the treatment will fight cancer, but how it might impact your quality of life.
