Bladder Cancer: Treatment Choices

There are many ways to treat bladder cancer. Your treatment options depend on these factors:

• The type of bladder cancer you have

• Where the tumor is and how big it is

• Grade and stage of the cancer

• If the cancer has spread to other parts of your body

• Your overall health and health history

• How you feel about the risks and side effects of different treatments

• Your choices and preferences

You’ll work with your cancer care team to decide on a treatment plan. Talking about your treatment choices will be one of the most important meetings you’ll have with your healthcare provider.

It may take time to choose the best treatment plan. Ask your healthcare provider how much time you can take to learn more about your options. You may want to get a second opinion from another provider before deciding on treatment. You may also want to talk with your family and friends. In fact, it’s helpful to bring loved ones with you to appointments. This can help you deal with the medical information and remember all of your questions. A written list will also make it easier for you to remember your questions. You may find it helps to take notes, too.

Understanding the goals of treatment for bladder cancer

Treatment for bladder cancer may have one or more of these goals. Be sure you understand the goals of your treatment before it starts: 

• Remove or kill the cancer cells.

• Kill any cancer cells that may have spread.

• Prevent or delay the cancer from coming back.

• Slow the growth of cancer and treat symptoms when the cancer can't be cured.

• Have as few side effects from the treatment as possible, and control the ones that you do have.

Types of treatment for bladder cancer

Several types of treatment may be used for bladder cancer. Sometimes more than one type of treatment is used.  

Surgery

This is a common treatment for bladder cancer. You’ll likely need to stay in the hospital for surgery. You’ll also be given medicines that put you into a deep sleep so you don't feel pain during surgery (anesthesia). There are different types of surgery. The kind your healthcare provider suggests depends on how big and where the cancer is (the stage of the cancer). In some cases, the surgeon takes out only the tumor or tumors. Though it's not common, some people may have only part of the bladder removed. In other cases, the whole bladder is taken out.

Intravesical therapy

This treatment is used with early-stage (small) bladder cancer that's only in the lining of the bladder. In intravesical therapy, liquid medicines are put right into your bladder for about two hours. Chemotherapy or immunotherapy medicines may be used. This kills the cancer cells in your bladder. But it has little effect on the rest of your body.

Chemotherapy (chemo)

Chemo uses strong medicines to kill cancer cells. This treatment can be given either alone or along with radiation. It may be given before or after surgery. It’s often needed when bladder cancer has spread to other parts of your body. The kind of chemo you get depends on the type of bladder cancer. It may be given by putting the medicines right into your bladder. This is called intravesical chemo. It may also be given by putting it into your blood through a vein. This is done to kill cancer cells all over your body. It's called systemic chemo.

Radiation treatment

Radiation uses high-energy rays to kill or shrink cancer cells. Internal or external radiation, or both, may be used to treat bladder cancer. With internal radiation, a radiation implant is put into your bladder. There it can directly kill nearby cancer cells. External radiation uses a machine outside the body that aims the rays at a broader area. Radiation can be given alone or with chemo. This treatment can also be given after surgery to help destroy cancer cells that may still be in the bladder. It might be used to ease problems the tumor is causing, too. For instance, radiation might be used to quickly shrink a tumor that's blocking a ureter so urine can pass from the kidney into the bladder the way it should.

Immunotherapy

Immunotherapy works with your immune system to fight cancer. It may be used as intravesical therapy for cancer that's only in the lining of the bladder. It turns on the immune cells in the bladder so they kill the cancer cells there. It can also be given through a vein and into your blood as a systemic treatment for cancers that have spread beyond the bladder. It can help your immune system find and kill cancer cells throughout your body.

Targeted therapy

Targeted therapy uses medicines to block the action of certain proteins on cancer cells that cause them to grow and spread. You may get a biomarker test to help predict how well your cancer will respond to certain targeted therapy medicines. Examples of targeted therapy medicines for bladder cancer include enfortumab vedotin-ejfv and erdafitinib.

Working with your healthcare provider

Sometimes new treatments are available in a clinical trial. Clinical trials are research studies used to learn more about new treatments. You can ask your healthcare provider about clinical trials that might be right for you.

Some people use complementary treatments. This means they get standard cancer treatment, such as surgery or chemo, along with other supportive ones, such as yoga, acupuncture, or certain diets. Talk about this option with your healthcare provider before making any changes.