Treatments and drugs

By Mayo Clinic Staff

Your 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.

Treatments 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 a cystoscope and into your bladder. The loop is used to burn away cancer cells with an electric current. 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.
  • 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 is rarely used and may only be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function.
  • 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).

    One biological therapy drug used to treat bladder cancer is bacille Calmette-Guerin (BCG), which is a bacterium used in tuberculosis vaccines. Another biological therapy drug is a synthetic version of interferon, which is a protein your immune system makes to help fight infections. The synthetic version, called interferon alfa-2b (Intron A), is sometimes used in combination with BCG.

    Biological therapy drugs often cause flu-like symptoms and can irritate your bladder.

Surgery for invasive bladder cancer

If your cancer has invaded the deeper layers of the bladder wall, you may consider:

  • 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.

    Increasingly, radical cystectomy is performed using robotic surgery, which means the surgeon sits nearby and uses hand controls to precisely move the surgical instruments.

    Cystectomy carries a risk of infection and bleeding. In men, removal of the prostate and seminal vesicles may cause erectile dysfunction. But in select cases, your surgeon can attempt to spare the nerves necessary for an erection. In women, removal of the ovaries causes infertility and premature menopause.

  • 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 situation and your preferences.

    Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your ureters, which drain your kidneys, to the outside of your body, where your urine empties 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 neobladder.

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 surgery. 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 in very select cases when surgery isn't an option.

Radiation therapy

Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy for bladder cancer usually is delivered from a machine that moves around your body, directing the energy beams to precise points.

Radiation therapy can be used after surgery to kill any remaining cancer cells. In very select cases, radiation therapy is sometimes combined with chemotherapy when surgery isn't an option, though this is generally considered an option of last resort.

June 30, 2015