Learn: Treatments

This section explains the common treatments for bladder cancer. But do remember that your treatment will depend on your detailed diagnosis. If you have not read it yet, it is probably a good idea to visit our Just Diagnosed section before coming back here.

Treatment normally begins with a ‘minor’ surgical operation called a TURBT (which stands for a Transurethral Resection of Bladder Tumour). The urologist uses a cystoscope to look inside your bladder and remove as much of the cancer as possible, which is then analysed by the pathologist to establish your exact diagnosis. As the operation is about cutting out the cancer, there will be some side effects afterwards, which are likely to include bleeding and some pain.

Your medical team will aim to remove all the cancer cells during the TURBT procedure, but they will further refine their treatment recommendations as the procedure progresses, and once they have the additional results from any biopsy. They will recommend treatment based on limiting the risk of the cancer coming back or spreading further than the lining of your bladder.

Your medical team will look at the results from your TURBT to help decide on the best treatment for you. This will depend on the stage of the cancer and its grade, which help predict your risk.

The risk

The risk of the cancer coming back or spreading will influence what treatment is best for you. This risk is calculated using a number of factors, including:

  • the number of tumours present in your bladder
  • whether the tumours are larger than 3 cm (1 inch) in diameter
  • whether you have had bladder cancer before
  • whether the tumours are limited to your bladder lining, or whether they’ve started spreading beyond the lining (the stage)
  • the grade of the cancer cells – this describes how aggressively they are likely to grow and spread, with low grade being the least aggressive and high grade being the most aggressive

We explain these terms in more detail in our Just Diagnosed section.

Treatment

The exact treatment you will be offered depends on your medical team’s view of the risk of your cancer returning.

 

Treatment for non-invasive bladder cancer

Non-invasive bladder cancer is a bladder cancer that hasn’t spread into the muscle of your bladder and is kept inside the lining of the bladder. The vast majority of bladder cancers, over 70%, are found at this stage. This is also sometimes called ‘superficial bladder cancer’ or ‘early-stage bladder cancer’.

Bladder cancer does, however, have the highest recurrence rate. So if your cancer is aggressive, you are likely to have a lifetime relationship with investigations and treatments as your medical team works to remove the tumours and help prevent them coming back. You will have regular check-ups with a cystoscopy to see if the bladder cancer has come back, and your treatment will begin again if it does.

What further treatments might I be offered?

In cases of non-invasive bladder cancer, it is usually possible to remove the cancer cells and leave the rest of the bladder intact using a TURBT procedure. This should normally be followed by a single dose of chemotherapy, which is placed directly into the bladder to prevent the cancer from returning. This method of chemotherapy reduces the risk of some side effects, such as hair loss. It is best practice that this TURBT procedure is repeated a few weeks later to make sure they have removed all the cancer.

If you were diagnosed with a low-grade (non-aggressive) bladder cancer, this will likely be all the treatment you need. But do look out for any symptoms as it can still come back, and if it does, you will need further treatment. Your medical team will explain what to look out for before you are discharged.

If your cancer is an aggressive type, it is likely that your treatment will also include a medication known as BCG (Bacillus Calmette-Guerin) which is inserted into your bladder with a catheter. BCG has been found to encourage the immune system to destroy any remaining cancerous cells. The immune system is the body’s natural defense against infection and illness. The BCG treatment is commonly carried out over a number of weeks in outpatient appointments. If you are about to start treatment with BCG we would recommend that you join our Confidential Forum to speak to others who have had this treatment. They can share their experiences and tips for dealing with the treatment course.

The side effects of BCG treatment range from very mild to, being honest, quite difficult. However, these side effects don’t last too long and it won’t be long, and life will soon be back to normal.

For some people with a very aggressive non-invasive bladder cancer, it might be suggested that the best treatment is bladder removal. This might sound dramatic, but it can be worth considering in conjunction with your medical team. It is a very common treatment if your bladder cancer has become invasive so it is discussed below in more detail.

Treatment for invasive bladder cancer

Invasive bladder cancer (sometimes called muscle invasive bladder cancer) is when the cancer has spread into the muscle of your bladder or possibly even further, into adjacent organs. While this is the more serious of the two basic types of bladder cancer, there are two forms of treatment that can be very successful. These are radiotherapy or bladder removal surgery.

Current knowledge is that both give an equal chance of survival for invasive bladder cancer, so, if both types of treatment are suitable to you, it will be a personal decision which one you choose. As always, do talk about the alternatives with your medical team.

There are two different treatments for invasive bladder cancer: removing your bladder by surgery or using radiotherapy to destroy the cancer.

For historical reasons, the most common treatment is having your bladder removed. However, the latest guidelines from NICE issued in February 2015 state that you should be offered both if there isn’t a medical reason not to.

Having a radical cystectomy to treat your bladder cancer

Radical cystectomy (RC) is the removal of your bladder together with the nearby lymph nodes, part of the urethra, the prostate (in men) and the cervix and womb (in women). It is a major operation, lasting at least 6 hours, but gives the best chance of removing the cancer permanently. Recently, some RCs have been carried out using robotic surgery, but currently there is limited evidence to say whether this is better than the traditional surgeon’s method. Be prepared to feel quite weak immediately after the operation but remember, it is likely that you will be able to go home within a week or 10 days.

Having an RC carries the obvious disadvantage of the loss of normal bladder function. To compensate for this, the surgery will include a way to create an alternative method for your wee to leave your body. This is called a urinary diversion, and there are a number of different ones that you might have the opportunity to choose between.

The options are usually:

  • a urostomy
  • bladder reconstruction
  • continent urinary diversion

Having radiotherapy to treat your bladder cancer

Radiotherapy is the alternative treatment option for invasive bladder cancer.

It uses pulses of radiation to destroy cancerous cells, and allows you to keep your bladder. There are two main ways that radiotherapy can be used to treat bladder cancer:

  • as a primary treatment to try and cure your bladder cancer; this may be the preferred option if your general health is less good.
  • to help control the symptoms in cases of incurable bladder cancer as a palliative treatment.

Sessions of radiotherapy for bladder cancer are usually given on a daily basis for 5 days a week over the course of between 4 and 7 weeks. Each session will last for around 10 to 15 minutes. As well as destroying the cancer cells, radiotherapy can also damage healthy cells, which means it can cause a number of different side effects. These include:

  • diarrhoea
  • inflammation of the bladder, which causes pain when weeing as well as an increased need to wee
  • tightening of the vagina in women and erectile dysfunction in men
  • loss of pubic hair
  • infertility

With the exception of infertility, these side effects should pass a few weeks after you finish treatment.

Surgery or radiotherapy?

Your medical team should recommend which treatment you should have, based on your individual circumstances and your personal preferences.

For example, surgery is often recommended in cases where the bladder cancer is more advanced because it is usually more effective in preventing the cancer from returning. Radiotherapy is treatment for many patients and may be preferred for patients whose general health is less good. In the end it will be a matter of personal choice. Do discuss the pros and cons of the proposed treatment with your consultant.

Chemotherapy

There are three main ways that chemotherapy can be used in the treatment of invasive bladder cancer:

  • before radiotherapy and surgery to shrink the size of any tumours
  • in combination with radiotherapy before surgery (called chemoradiation)
  • to slow the spread of incurable bladder cancer

If you are treated with chemotherapy, a specific combination of different chemotherapy medications will be injected into your veins. This treatment varies according to your specific needs, but is often a combination of drugs given to you on a number of days over a 28-day period, which can be repeated on your treatment path.

The side effects of having the chemotherapy injected directly into you can include:

  • feeling sick
  • being sick
  • losing your hair
  • not feeling hungry
  • feeling tired

These side effects should stop after your treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infections. If you do get any symptoms of an infection such as a high temperature, persistent cough or reddening of the skin, make sure you see your doctor immediately. 

Find out more about all the different treatments for bladder cancer and their side effects in our Treatments, side effects and how to cope downloadable guide. You can find this in the LEARN section on our Downloads page.

Advanced bladder cancer

Advanced bladder cancer is when the cancer has spread to other parts of your body. It might be advanced at your first diagnosis or come back in this form after initial treatment. It can be what is called ‘local spread’ which means that it is still within the pelvic cavity, or it could have spread to another part of your body, when it is called ‘secondary cancer’ or ‘metastasis’.

The vast majority of bladder cancers do not spread outside the bladder. If they do, they will most likely spread to the lymph nodes in the pelvis, tummy or neck, or to the lungs, liver or bones.

The symptoms of advanced bladder cancer depend on which part of the body the cancer has spread to. A common symptom is weight loss.

Other symptoms can include:

  • swollen legs
  • pain in your bones or tummy
  • lumps in your abdomen or neck
  • yellowing of the skin or whites of the eyes (jaundice)

Remember that from time to time, you are likely to have aches and pains, and days when you don’t feel very good, that are not related to your cancer. But you may worry that they are due to the cancer or its treatment. Do check with your doctor or specialist nurse about any symptom that is worrying you. They will be able to reassure you. If the symptoms are due to the cancer, they can give you some treatment to help you feel better.

The treatments for bladder cancer can be very specific depending on where it has spread.

We have more information on the detailed treatments in our Advanced bladder cancer download.

Can we help?

We’ve done everything we can to make all the information on this site as accurate as possible. Whilst we have had support from a small team of medical professionals advisors to review the general medical content of this site, please remember, that only YOUR medical team can give YOU specific advice about YOUR symptoms or illness. We encourage you to discuss any potential options with them.