Treatment depends on the stage of the cancer, the severity of your symptoms, and your overall health.
Stage 0 and I treatments:
- Surgery to remove the tumor without removing the rest of the bladder
Chemotherapy or immunotherapy placed directly into the bladder
Stage II and III treatments:
- Surgery to remove the entire bladder (radical cystectomy) and nearby lymph nodes
- Surgery to remove only part of the bladder, followed by radiation and chemotherapy
- Chemotherapy to shrink the tumor before surgery
- A combination of chemotherapy and radiation (in patients who choose not to have surgery or who cannot have surgery)
Most patients with stage IV tumors cannot be cured and surgery is not appropriate. In these patients, chemotherapy is often considered.
Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.
For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder.
A Foley catheter can be used to deliver the medication into the bladder. Common side effects include bladder wall irritation and pain when urinating. For more advanced stages (II-IV), chemotherapy is usually given by vein (intravenously).
Bladder cancers are often treated with immunotherapy. In this treatment, a medication triggers your immune system to attack and kill the cancer cells. Immunotherapy for bladder cancer is usually performed using the Bacille Calmette-Guerin vaccine (commonly known as BCG). A medicine called Interferon is sometimes used. It is given through a Foley catheter directly into the bladder. If BCG does not work, patients may receive interferon.
As with all treatments, side effects are possible. Ask your doctor what side effects you might expect, and what to do if they occur.
Surgery for bladder cancer includes:
- Transurethral resection of the bladder (TURB): Cancerous bladder tissue is removed through the urethra.
- Partial or complete removal of the bladder: Many people with stage II or III bladder cancer may need to have their bladder removed (radical cystectomy). Sometimes only part of the bladder is removed. Radiation and chemotherapy is usually given after this surgery.
Surgery may also be done to help your body drain urine after the bladder is removed. This may include:
- Ileal conduit: A small urine reservoir is surgically created from a short piece of your small intestine. The ureters that drain urine from the kidneys are attached to one end of this piece. The other end is brought out through an opening in the skin (a stoma). The stoma allows the patient to drain the collected urine out of the reservoir.
- Continent urinary reservoir: A pouch to collect urine is created inside your body using a piece of your intestine. You will need to insert a tube into an opening in your skin (stoma) into this pouch to drain the urine.
- Orthotopic neobladder: This surgery is becoming more common in patients who had their bladder removed. A part of your bowel is folded over to make a pouch that collects urine. It is attached to the place in the body where the urine normally empties from the bladder. This procedure allows you to maintain some normal urinary control.