Bladder Cancer Treatment Options

This page is for people with bladder cancer, and their families, who want to understand the treatment options. It covers early (non-muscle-invasive) cancer, muscle-invasive cancer, and cancer that has spread.

Bladder cancer treatment splits into two paths. It depends on one question. Has the cancer grown into the muscle layer of the bladder wall?

Non-muscle-invasive bladder cancer is usually treated while keeping the bladder in place. Doctors use scope-based procedures. They also use medicine placed directly in the bladder. Muscle-invasive bladder cancer usually needs more aggressive treatment. This often includes removing the bladder itself.

The first step is a procedure called TURBT. That stands for transurethral resection of bladder tumor. A cystoscope — a thin, lighted tube — passes through the urethra (the tube that carries urine out of the body) into the bladder. The tumor is removed or burned away, using electrical energy sent through the scope. This both treats the tumor and gives the pathologist tissue. That tissue confirms the exact stage and grade.

After TURBT, many people get intravesical therapy. This is medicine put into the bladder through a tube inserted into the urethra.

BCG (bacillus Calmette-Guérin) is an immunotherapy given this way. Chemotherapy drugs such as mitomycin and gemcitabine can also be put into the bladder. Your team chooses based on your tumor.

Non-muscle-invasive bladder cancer often comes back, so follow-up checks afterward are part of care. Your care team will set the schedule.

Once cancer has grown into the muscle layer, treatment generally becomes more extensive. Chemotherapy — usually cisplatin-based — is often given before surgery. This can shrink the tumor and reduce the amount of tissue that needs to be removed.

Radical cystectomy is the standard surgery for muscle-invasive disease. It removes the entire bladder, plus nearby lymph nodes. Depending on your anatomy, it may also remove nearby organs. In men, that can mean the prostate and seminal vesicles. In women, it can mean the uterus, ovaries, and part of the vagina.

Because the bladder is gone, surgeons create a new way for urine to leave your body. This is called a urinary diversion. One option is an opening in the belly that connects to a bag outside the body. Other options redirect urine inside the body. Which option fits depends on your anatomy, health, and preferences. This is worth discussing in detail before surgery. It's one of the most life-changing parts of treatment.

Partial cystectomy removes just part of the bladder. NCI says it may be an option for a low-grade tumor that has grown into the bladder wall but is limited to one area.

For people who aren't surgery candidates, or who want to avoid losing the bladder, there's another path. It combines TURBT, chemotherapy, and radiation. Doctors sometimes call this trimodal therapy. NCI's clinician summary describes radiation with chemotherapy as an alternative to cystectomy for selected people.

When bladder cancer has spread beyond the bladder, treatment can include chemotherapy and immunotherapy. NCI names the checkpoint inhibitors atezolizumab, avelumab, nivolumab, and pembrolizumab for urothelial cancer. Your team will explain which drugs fit your situation.

So much depends on whether the cancer has invaded the muscle layer. These questions shape both the treatment and what daily life looks like afterward:

• Is my cancer muscle-invasive or non-muscle-invasive? How confident is that?
• If removing my bladder is being discussed, what are my urinary diversion options?
• Is a bladder-preserving approach reasonable for my situation?

• National Cancer Institute — Bladder Cancer Treatment (PDQ) Patient Version.
• National Cancer Institute — Bladder Cancer Stages.