Transurethral resection (TUR)

Doctors commonly perform this surgery to treat early stage bladder cancer. In a transurethral resection, your doctor uses a resectoscope, a surgical instrument with a wire loop on the end. Your doctor passes the resectoscope through the urethra and into the bladder, and scrapes your tumor from the lining of your bladder with the wire loop.

Cystectomy

During this procedure the doctor removes all or part of the bladder. Doctors perform this surgery to treat more advanced stages of bladder cancer. In some cases, your doctor may be able to perform a partial cystectomy and remove only part of the bladder. In most cases, your doctor will need to remove the entire bladder (radical cystectomy), along with the prostate in men. In women, they may need to remove the uterus, ovaries, fallopian tubes, and part of the vagina in women. It is also important for the doctor to perform a complete bilateral lymph node dissection as part of this operation. Lymph nodes will be removed and sent to a pathologist to be examined under a microscope.

Bladder reconstruction

If your bladder is removed in a radical cystectomy, you will need surgery to give your body a new way to store urine. Your doctor will perform this procedure at the same time as your cystectomy. Your doctor may use part of the small intestine to create a new bladder (ileal neobladder). Your doctor may also use part of your small and large intestine to create a sac inside your body to collect urine (continent diversion). This sac will need to be emptied periodically with a catheter.

Urinary diversion

Your doctor may also use a part of your small intestine to connect your ureters to a hole in your abdomen (ileal conduit). Urine then drains out of this hole and collects in a bag outside your body.

Chemotherapy

Chemotherapy is the use of drugs to treat rapidly growing cancer cells in an effort to destroy them. Chemotherapy is the primary treatment for advanced bladder cancer that has spread to other parts of the body. Doctors commonly give chemotherapy before surgery (neoadjuvant chemotherapy) to increase the chances of a successful surgery. Chemotherapy medications are typically given through the vein (intravenously).

Radiation Therapy

During radiation thereapy, high-energy rays can be used to kill cancer cells in the area being treated. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. Radiation therapy is used to treat muscle invasive disease, typically when the patient either refuses surgery or is a poor candidate for surgery. Your doctor may also recommend a combination of radiation therapy and chemotherapy to treat more advanced cases of bladder cancer.

Biological Therapy (Immunotherapy)

Immunotherapy stimulates your body's immune system to help it fight off cancer.  It can be either inside the bladder for stage 0 and stage I bladder cancer. In this scenario, your doctor uses a catheter to fill your bladder with a medication that stimulates your immune system within the bladder, and helps it destroy cancer cells.   Another way of using immunotherapy is intravenously using a different set of drugs for stage IV bladder cancer. Sometimes intravenous immunotherapy is combined with chemotherapy or other intravenous drugs depending on the circumstances.

Antibody-drug conjugates

Antibody-drug conjugates are a targeted cancer treatment that combine chemotherapy with lab-engineered antibodies that recognize specific cancer cells. This allows the chemotherapy to be delivered directly to cancer cells, helping to reduce damage to healthy tissue and limit side effects.

Currently, ADCs are approved only for patients with metastatic bladder cancer. Ongoing research is exploring their potential for use in earlier stages of the disease.

Immune Checkpoint Inhibitors

Immune checkpoint inhibitors are a form of immunotherapy that help the immune system stay active longer to fully attack and eliminate cancer cells. They work by blocking signals that would otherwise tell the immune system to stop its response too soon.

For bladder cancer, these therapies are currently used in stage IV disease. Clinical trials are investigating whether they may also be effective in earlier stages or different treatment settings.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.