What are my bladder cancer treatment options?
Bladder cancer treatments include surgery, chemotherapy and radiation therapy. Most of the time, initial treatment of bladder cancer is based on the tumor’s clinical stage, which is how deep it is thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size and grade of the tumor, may also affect treatment options. All of these are based on the results of exams, cystoscopy and imaging tests.
Treatment for Each Stage
Stage 0 bladder cancer includes noninvasive papillary carcinoma (Ta) and flat noninvasive carcinoma (Tis). In either case, the cancer has not invaded the bladder wall beyond the inner layer. This early stage of bladder cancer is most often treated with surgery.
Stage 0a: For low-grade noninvasive papillary (Ta) tumors, the options include surgery and chemotherapy.
Stage 0is: For flat noninvasive (Tis) tumors, surgery and chemotherapy are the treatment of choice.
Following treatment for any stage 0 cancer, close follow-up is recommended, with cystoscopy about every 3 to 6 months for a least a couple of years to look for signs of the cancer coming back or for new bladder tumors.
The outlook for people with stage 0a (noninvasive papillary) bladder cancer is excellent. These cancers are nearly always cured with the right treatment. During long-term follow-up care, more superficial cancers are often found in the bladder or elsewhere in the urinary system. Although these new cancers do need to be treated, they rarely are deeply invasive or life threatening.
The long-term outlook for stage 0is (flat noninvasive) bladder cancer is not quite as good as for stage 0a cancers. These cancers have a higher risk of coming back and may return as a more serious cancer, one that is growing into deeper layers of the bladder or has spread to other tissues.
Stage I bladder cancers have grown into the connective tissue layer of the bladder wall but have not reached the muscle layer. Surgery is typically the initial treatment for these cancers.
These cancers have invaded the muscle layer of the bladder wall. Transurethral resection (TUR) is typically the first treatment for these cancers, but it is done to help determine the extent of the cancer rather than to try to cure it. Treatment options include chemotherapy before or after surgery, or surgery followed by radiation and chemotherapy.
These cancers have reached the outside of the bladder and might have grown into nearby tissues or organs. Treatment options include chemotherapy before surgery to shrink the tumor, in some cases chemotherapy after surgery and in other cases surgery followed by radiation and chemotherapy.
These cancers have reached the abdominal or pelvic wall (T4b tumors) or have spread to nearby lymph nodes or distant parts of the body.
In most cases surgery cannot remove all of the cancer at this stage, so these cancers are very hard to get rid of completely. Treatment is usually aimed at slowing the cancer’s growth and spread. If you and your doctor discuss surgery as treatment option, be sure you understand the goal of the operation – whether it is to try to cure the cancer, to help you live longer or to help prevent or relieve symptoms from the cancer – before deciding on treatment.
For stage IV bladder cancers that have not spread to distant sites, chemotherapy (with or without radiation) is usually the first treatment. If the cancer shrinks in response to treatment, surgery may be an option. Patients who can’t tolerate chemotherapy (because of other health problems) are often treated with radiation therapy.
For stage IV bladder cancers that have spread to distant areas, chemotherapy is usually the first treatment, sometimes along with surgery or radiation therapy. Patients who can’t tolerate chemotherapy (because of other health problems) are often treated with radiation therapy.
Recurrent bladder cancer
When a cancer comes back after treatment, it is called recurrent. If cancer continues to grow during treatment or comes back, further treatment depends on the extent of the cancer, treatments that have been used, your health and whether you want further treatment.