Bladder Cancer Treatments: What to Know

If you have bladder cancer, there are several available treatment options. Your doctor will help you decide which treatment is best for you. This will depend on a number of things, including your age, how much the cancer has spread (doctors call this your cancer “stage”), and any other health conditions you have.

Many people with bladder cancer need surgery. But in some cases, it can’t remove all of the disease. So you’ll need other treatments along with, or instead of, an operation. These could include chemotherapy, radiation, and immunotherapy.

Surgery

Transurethral resection of bladder tumor (TURBT, also known as transurethral resection, or TUR) is the most common surgery for bladder cancer that’s in the early stages.

It’s a procedure used to take samples of tissue from inside your bladder to find out if you have cancer there or if a tumor has spread, or to take out a tumor.

You first may need a blood test and chest X-ray to make sure you’re healthy enough to have TUR surgery, but your surgeon won’t need to make a cut into your skin. They get to your bladder through your urethra, the tube that pee goes through as it passes out of your body.

Before the surgery, you’ll have either general anesthesia -- which puts you to sleep -- or regional anesthesia that numbs just the lower part of your body. The procedure starts once that medicine starts to work.

Your surgeon uses a special tool called a cystoscope, a long, thin, flexible tube that has a cutting tool, a light, and a camera at the end of it. They pass it through your urethra into your bladder. The camera shows the surgeon the inside of your bladder.

Your doctor can also put a similar instrument called a resectoscope into your bladder through your urethra. It has a wire loop at the end.

They’ll use the cutting tool or the wire loop to take out tissues or tumors, and then they’ll use heat on the areas around the cut to stop the bleeding.

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The tissue that’s taken out will be looked at under a microscope in a lab to see if it’s cancer.

After the procedure, you’ll have a tube in your bladder called a catheter. It takes pee out of your body and into a bag. You may need to have it in for a few days before you can go on your own. You can get up and walk when you have a catheter, but as the anesthesia wears off, it may feel uncomfortable.

Men sometimes feel pain at the tip of the penis afterward. If you do, be sure to let your doctor or nurse know. A numbing gel can help.

Many people go home the same day as the surgery. But if your tumor was large, you may need to stay in the hospital overnight.

You may see blood in your pee for up to 3 days after your surgery. Drink lots of fluid to help flush out your bladder -- aim for eight to 10 glasses per day. This also can help keep an infection away.

Don’t lift anything heavy for 2 to 3 weeks after your surgery. Short walks are OK, but don’t do any intense exercise for 4 to 6 weeks. Talk with your doctor about when you can drive and go back to work.

Cystectomy

In this type of surgery, your doctor removes part of your bladder (a partial cystectomy) or all of it (a radical cystectomy).

If cancer has spread to the muscle layer of your bladder and is still small, your doctor may be able to perform a partial cystectomy. But most people who have cancer that has grown into the muscle of the bladder will need a more extensive surgery instead.

If the cancer is large or has spread to more than one part of your bladder, your doctor will likely remove the entire organ and the nearby lymph nodes. This is a radical cystectomy.

If your cancer has spread farther, the surgeon can also remove nearby reproductive organs and structures. In women, this can mean the uterus, cervix, part of the vagina, the ovaries, and the fallopian tubes. In men, this usually means the prostate gland and can also include the seminal vesicles and vas deferens.

For these procedures, you’ll be given medication so that you won’t be awake. You may have to stay in the hospital for up to a week afterward. Usually, you can go back to your normal routine in a few weeks.

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Intravesical Therapy

This treatment is also used for early-stage cancers. Your doctor uses a catheter to inject a liquid medication right into your bladder. They will choose between two types of medications: immunotherapy or chemotherapy (“chemo”).

  • Immunotherapy. In this method, your body’s own immune system attacks the cancer cells. Your doctor will inject a germ called Bacillus Calmette-Guerin (BCG) into your bladder through a catheter. This germ is related to the one that causes tuberculosis. This draws your body’s immune cells to your bladder. There, they’re activated by the BCG and begin to fight the cancer cells.
  • Intravesical chemotherapy (“chemo”). If your doctor and you decide on this treatment, they’ll inject cancer-fighting medications into your bladder through a catheter. The chemo works to kill the harmful cells.

Chemotherapy

Your doctor may give you chemo in pill form or through an IV. That means the medication travels through your bloodstream to other parts of your body. It can kill cancer cells that may have spread beyond your bladder.

You get chemotherapy in cycles, giving you time between treatments to recover. Each cycle usually lasts for a few weeks, and total treatment time may be several months.

If you’re having surgery, you’ll most likely get chemotherapy before the procedure. It can help shrink tumors, which makes them easier to remove and makes surgery safer. This also makes it less likely that the cancer will come back.

Doctors often use the chemo drug cisplatin to treat the most common type of bladder cancer, called urothelial carcinoma. Cisplatin works by damaging the DNA of cancer cells so they can’t reproduce.

Cisplatin is often used along with other chemotherapy drugs. The most common combinations are:

If your kidneys don’t work well, you may get a different set of chemo drugs, such as carboplatin and either paclitaxel, gemcitabine, or docetaxel.

Your doctor can order chemo after surgery to kill any cancer cells that remain in your body but are too small or scattered for your surgeon to remove them. It lowers the chance that your cancer will return.

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Radiation Therapy

This treatment involves using high-energy radiation to kill cancer cells. It’s a lot like getting an X-ray -- only much stronger. It doesn’t hurt. You might need to get radiation 5 days a week for several weeks.

Your doctor may recommend it for one of the following reasons:

  • You have early-stage bladder cancer
  • You have early-stage cancer but can’t have surgery
  • As a follow-up to TURBT or partial bladder removal surgery
  • To prevent or treat symptoms of advanced bladder cancer

Treatments After or Instead of Surgery

Sometimes, doctors will use a mix of chemotherapy and radiation therapy to avoid surgery to remove the bladder. It can be a good option if you’re not healthy enough for surgery. In this case, you will likely take the chemo drug cisplatin by itself, cisplatin and fluorouracil, or mitomycin with fluorouracil.

You may also get chemotherapy and radiation together after surgery if your cancer has grown into the muscle layer of the bladder but hasn’t spread elsewhere.

If your cancer spreads after chemo, you can try other chemotherapy drugs or other types of medicine, like immunotherapy.

Immunotherapy

This treatment uses your immune system to attack the cancer. It helps your immune system recognize cancer cells as dangers and launch a stronger response against them. That can shrink tumors or stop them from growing.

Several immunotherapy drugs are used to treat bladder cancer that has spread. These drugs are called checkpoint inhibitors. To keep your immune system from attacking normal cells, your body uses proteins called checkpoints. They help the immune system tell if other cells are a normal part of your body and should be left alone or invaders that should be attacked.

Cancer cells can trick your immune system by binding to the cells that are supposed to fight it. When that happens, the checkpoint signals your body not to attack. A checkpoint inhibitor stops these cells from binding. That way, your immune system recognizes and targets the cancer.

The FDA has approved several immunotherapy drugs for people who have metastatic bladder cancer that got worse during chemo. These medications are: atezolizumab (Tecentriq), avelumab (Bavencio), durvalumab (Imfinzi), enfortumab vedotin-ejfv (Padcev), nivolumab (Opdivo), and pembrolizumab (Keytruda).

These drugs are given every 2-3 weeks by infusion, which means through a tube (an IV) that goes into a vein.

One benefit of immunotherapy is it uses your body’s natural defenses. Once your immune system better recognizes cancer, it can continue to target those cells even if your treatment has ended.

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Other Immunotherapies for Bladder Cancer

Researchers are testing other potential immunotherapy drugs to see how well they work on their own and combined with other treatments.

They’re also testing combinations of immunotherapies. Early results showed that nivolumab combined with another drug, ipilimumab, worked in 26% to 38% of people who took them.

Studies are also looking at atezolizumab in combination with another checkpoint inhibitor called MTIG7192A.

Bladder Cancer Clinical Trials

Major drug companies continually research and develop new medications and treatments for bladder cancer that must be shown to be safe and effective before doctors can prescribe them to patients. Through clinical trials, researchers test the effects of new drugs on a group of volunteers who have bladder cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat bladder cancer, its safety, and any possible side effects.

Some patients are reluctant to take part in clinical trials for fear of getting no treatment at all. But patients who participate in clinical trials receive the most effective therapy currently available for the condition, or they may receive treatments that are being evaluated for future use. These bladder cancer drugs may be even more effective than current treatment. Comparing them in a clinical trial is the only way to find out.

Here’s where to find information about whether a bladder cancer clinical trial is right for you.

National Cancer Institute

This website lists more than 8,000 cancer clinical trials and explains what to do when you find one that you think is right for you.

ClinicalTrials.gov

This website offers up-to-date information for locating federally and privately supported clinical trials for cancer.

CenterWatch

This website lists industry-sponsored clinical trials that are actively recruiting patients.

WebMD Medical Reference Reviewed by Michael W. Smith, MD on September 04, 2020

Sources

SOURCES:

American Cancer Society: “Bladder Cancer Treatment,” “Bladder Cancer Surgery,” “Radiation Therapy for Bladder Cancer,”  “Chemotherapy for bladder cancer,” “FDA Approves New Immunotherapy Drug for Bladder Cancer,” “Immunotherapy for bladder cancer.”

National Cancer Institute: “Bladder Cancer Treatment (PDQ) -- Patient Version,” "FDA Approves Immunotherapy Drugs for Patients with Bladder Cancer,” “FDA Approves New Immunotherapy Drug for Bladder Cancer,” “Immunotherapy.”

American Society of Clinical Oncology: “Bladder Cancer: Treatment Options.”

Cancer Research UK: “Trans Urethral Removal of Bladder Tumour.”

University Hospital Southampton: “Transurethral Resection of Bladder Tumor Information for Patients.”

University of Cincinnati Cancer Center: “Treating Bladder Cancer: TUR (Transurethral Resection).”

NYU Langone Medical Center: “Intravesical Treatment for Bladder Cancer,” “Radiation Therapy for Bladder Cancer,” “Surgery for Bladder Cancer,” “Chemotherapy and New Treatments for Bladder Cancer.”

Memorial Sloan Kettering Cancer Center: “Neoadjuvant Chemotherapy for Bladder Cancer,” “Bladder Cancer Clinical Trials and Research,” “Immunotherapy,” “FDA Approves ‘Game Changer’ Immunotherapy Drug for Bladder Cancer,” “A Phase II Study Assessing Mediators of Response to Nivolumab and Ipilimumab Immunotherapy in Patients with Advanced Melanoma or Bladder Cancer,” “A Phase I/IB Study of Immunotherapy with CPI-444 Alone and with Atezolizumab in Patients with Metastatic Solid Tumors.”

FDA: “FDA approves new, targeted treatment for bladder cancer,” “Nivolumab for Treatment of Urothelial Carcinoma.”

ISRN Urology: “Metastatic Bladder Cancer: A Review of Current Management.”

The University of Texas MD Anderson Cancer Center: “Q&A Understanding Immunotherapy,” “Nivolumab immunotherapy helps patients with advanced bladder cancer,” “Immune checkpoint inhibitors shrink tumors in 26 to 38 percent of metastatic bladder cancer patients.”

American Society of Clinical Oncology: “Patients With Advanced Bladder Cancer Benefit From Anti-PD-L1 Immunotherapy.”

The Lancet: “Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial.”

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