Bladder Cancer

Treatment

Surgery is the primary treatment for bladder cancer. Immunotherapy, chemotherapy, and radiation therapy may also be used when appropriate for a patient.

Surgery

For early-stage cancer that cannot be treated with immunotherapy, surgery to remove the cancer occurs through a cystoscope. The doctor inserts the tube through the channel (urethra) that carries urine from the bladder and out of the body. The doctor may cut away the cancer, burn it or destroy it with a high-energy laser.

After removal of a tumor, an examination with a cystoscope is required every three to six months for many years to determine if the cancer has recurred. During these follow-up exams, the doctor may use the cystoscope to remove a tissue sample (biopsy) for laboratory analysis.

More advanced cancer requires traditional surgery through an incision in the abdomen. In this surgery, the doctor may remove all or part of the bladder (cystectomy).

Bladder Reconstruction Surgery
When cancer is extensive, the entire bladder must be removed. In the past, patients have had few options for urinating in a natural fashion after the bladder was removed. Mayo Clinic urologists can now construct a new bladder (neobladder) to replace the cancerous bladder. The procedure was first performed in men and then adapted for women. Mayo Clinic urologists have found that women sometimes have better results from the procedure than men.

In bladder reconstruction, a new bladder is created from a section of small intestine during the surgery to remove the cancerous bladder. On average, the procedure takes a little more than four hours, followed by a hospital stay of six to seven days.

With this surgery, the capacity of the reconstructed bladder is well within the normal range. Patients are usually able to stay dry although urine leakage is a potential complication. There is no loss of kidney function over time after this procedure.

Experienced surgeons who are familiar with the procedure should be able to reliably identify surgery candidates in advance based on a CT scan and a preoperative exam. Age and the extent of the cancer are important factors in determining if a patient is a candidate.

Immunotherapy

This procedure is used to treat superficial bladder cancer. Immunotherapy involves placing foreign proteins (antigens) into the bladder through a narrow tube called a cystoscope. As the immune system responds to the antigens, it produces antibodies that attack and kill cancer cells at the same time.

Chemotherapy

After surgery, a combination of drugs may be used as a precaution to ensure the cancer has been destroyed. Chemotherapy is also used to control advanced cancer that has spread beyond the bladder.

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells. Radiation is also sometimes used to shrink a tumor before surgery, in conjunction with chemotherapy, or instead of surgery. Treatment with radiation therapy and chemotherapy following limited bladder surgery may be considered in select cases. This treatment option is reviewed by a multidisciplinary team of medical oncologists, radiation oncologists and urologists.