Bladder cancer treatment depends on whether the cancer is non-muscle invasive (early-stage) or muscle invasive (advanced), and typically involves one or more of TURBT surgery, intravesical therapy, chemotherapy, radiation, bladder removal surgery (cystectomy), systemic immunotherapy or targeted therapy.
Bladder Cancer Treatments
How is Bladder Cancer Treatment Decided?
Bladder cancer treatment decisions are driven primarily by stage and grade, not a single standard protocol. Whether the cancer has grown into the muscle wall of the bladder is the key dividing line for treatment: non-muscle invasive (early-stage) cancers are managed differently than muscle invasive or advanced disease. Your care team will also weigh your overall health, personal goals (including whether preserving the bladder is a priority), and how the cancer has responded to any prior treatment. Understanding your specific type, grade, and stage is the starting point for every treatment conversation with your doctor.
Treatments for Non-Muscle Invasive (Early-Stage) Bladder Cancer
70-75% of bladder cancers are caught before they invade the muscle wall. Treatment at this stage focuses on removing visible tumours and reducing the risk of recurrence.
Transurethral Resection of Bladder Tumour (TURBT)
TURBT is usually the first treatment given after a bladder cancer diagnosis. It’s a common procedure performed in a hospital where a tool is inserted into the bladder through the urethra to remove the tumours. TURBT both treats the cancer and provides tissue for staging and grading.
Bacillus Calmette-Guérin (BCG)
BCG is a type of immunotherapy used to treat bladder cancer and is administered directly into the bladder through the urethra (intravesical therapy). It’s typically given after TURBT to reduce the chance of the cancer returning. Some patients receive BCG on a maintenance schedule over an extended period to further lower recurrence risk.
Treatments for Muscle Invasive or Advanced Bladder Cancer
When bladder cancer grows into the muscle wall or spreads beyond the bladder, treatment becomes more intensive and usually involves surgery, systemic therapy, or a combination of both.
Chemotherapy and Radiation
Chemotherapy and radiation, either alone or in combination with surgery or other treatments, can be used to shrink cancer tumours.
Bladder Removal Surgery
Referred to as a Radical Cystectomy, this is the typical treatment for muscle invasive bladder cancer. This surgery can be used to completely remove the bladder or a section of it. Which diversion option is used depends on individual anatomy, health, and patient preference.
Immunotherapy
Immunotherapy is often given intravenously and works by stimulating the immune system, allowing immune cells to attack cancer cells.
Bladder Preservation
Chemotherapy, radiation and TURBT can be combined as an alternative to bladder removal for some muscle invasive bladder cancer cases, sometimes referred to as Trimodal Therapy (TMT).
Advanced/Metastatic Bladder Cancer Treatment
When cancer has spread to parts of the body outside the bladder, treatments can include chemotherapy, immunotherapy, or targeted therapy. These therapy options may be continued after the initial treatment, referred to as maintenance therapy.
Supportive and Additional Care Treatment Options for Bladder Cancer
Palliative Care
Palliative Care is a specialized medical care for people with serious illness focusing on providing relief from the symptoms and stress of a serious illness.
Clinical Trials
Clinical trials are research studies that explore new treatments for bladder cancer. They may provide possible treatment alternatives to patients who have not had success with standard and approved therapies.
Understanding Treatment Side Effects
Every bladder cancer treatment carries a different set of possible side effects. Surgery can affect urinary function and may require an adjustment period after a urinary diversion. Chemotherapy and radiation commonly cause fatigue and irritation of the bladder or surrounding tissue. Immunotherapy, including BCG, can cause flu-like symptoms, especially after the first few treatments.
Your care team can walk you through the specific side effects expected for your treatment plan and how they’re typically managed.