Bladder Cancer Treatment

Developing a Bladder Cancer Treatment Plan

Soon after your diagnosis, your team may order tests to assess the type of bladder cancer you have and its stage. Your team will need to know whether the cancer has grown into the bladder wall or spread to other organs.

Tests include:

• Cystoscopy — A thin, lighted tube with a camera is inserted through your urethra, allowing your provider to see inside your bladder. During the cystoscopy, your provider may also take a biopsy or tissue sample. The sample is sent to a lab, where it’s analyzed to see how fast the cancer cells are growing.
• Imaging tests — Your oncology team may need an X-ray, CT, MRI or ultrasound to measure the size and shape of a tumor and determine whether it has spread to other parts of your body.

The results of these tests will inform your care plan. Thanks to recent advances, you have many treatment options available. Your team will consider your cancer’s stage and grade, as well as your symptoms, health and treatment goals to determine the right treatment for you.

In many cases, bladder cancer care involves a combination of surgery, chemotherapy, radiation therapy and immunotherapy for effective results.

Bladder Cancer Surgery

Most people with bladder cancer will have one of the following types of surgery.

Transurethral Resection of Bladder Tumor (TURBT)

During a TURBT procedure, your provider inserts a thin, lighted instrument called a resectoscope through your urethra into your bladder. Your doctor will use the instrument to remove the tumor and surrounding cells. Depending on how the tumor has spread, they may use a high-energy current or laser to destroy nearby tissue to prevent cancer cells from returning.

The procedure is done under general or local anesthesia, and you can usually go home the same day or the day after your surgery and resume normal activities within a week or two.

TURBT is mainly used to treat early-stage cancers. Your oncology team may also order a TURBT to stage your cancer and determine what additional treatments you may need.

People who have TURBT may also have intravesical therapies, chemotherapy or immunotherapy medications inserted directly into the bladder through a catheter.

Cystectomy

If you have advanced bladder cancer that has spread to your bladder walls or other parts of your body, you may need surgery to remove the bladder, or cystectomy. Surgeons perform two types:

• Partial cystectomy — This surgery removes the tumor and part of the bladder wall, which is closed with stitches. It is the less common of the two types but can preserve your bladder function.
• Radical cystectomy — The entire bladder and nearby lymph nodes are removed. If you are a man, your prostate and seminal vesicles might also be removed. For women, radical cystectomy often involves removing the ovaries, uterus, fallopian tubes, cervix and part of the vagina.

Cystectomy can be done through a cut in your lower abdomen or using minimally invasive robot-assisted surgery, which can reduce recovery time.

Cystectomy typically requires a hospital stay of about a week, and recovery can take several weeks. Often, people who have a cystectomy also receive chemotherapy, immunotherapy or radiation therapy before or after the surgery to help shrink the tumor, destroy cancer cells or prevent cancer from coming back.

Before recommending a cystectomy, your urologist or surgeon will review the procedure’s pros and cons and ensure you feel comfortable with any potential risks and complications.

Reconstructive Surgery

After a radical cystectomy, you will need another surgery, urinary diversion, to create a way for urine to leave your body. Options include:

• Continent diversion — Your surgeon will take a piece of your intestine and create a small pouch that attaches to your ureters (the tubes that carry urine out of your kidneys). The pouch inside your body connects to a stoma, an opening in your skin, with a one-way valve. Your urine collects in the pouch, and you use a catheter inserted into the valve to empty urine.
• Incontinent diversion — Similar to continent diversion, your surgeon takes a small piece of your intestine and attaches one end to your ureters and the other end to a stoma on the outside of your stomach. The ureters will carry urine to the stoma and empty into a small bag. You’ll always wear the bag and empty it when it becomes full.
• Robotic radical cystectomy with ileal conduit or neobladder — Robotic radical cystectomy with ileal conduit or neobladder is a fully robotic surgery that involves the removal of the bladder, in which a piece of the intestine is used to create a new way for the body to store urine. With the neobladder method, the surgeon connects your ureters and your urethra to the newly created bladder, allowing you to urinate as you did before surgery. The new bladder doesn’t alert you when you need to go to the bathroom, so you must create and follow a urination schedule.

You might feel concerned about surgery and its impact on your life, especially if you have a radical cystectomy. Your Beaufort Memorial oncology team will offer support and answer questions about surgery or bladder reconstruction to ensure you have all the information necessary to make the right decision for your lifestyle.

Chemotherapy and Immunotherapy

Chemotherapy drugs kill cancer cells or stop them from dividing, while immunotherapy medications stimulate your immune system to attack and kill cancer cells.

Both treatments can be intravesical (inserted into the bladder) or systemic (injected into your bloodstream). Medical oncologists use many different chemotherapy and immunotherapy medications to treat bladder cancer and will educate you about the potential side effects of each one you receive.

Radiation Therapy

Radiation therapy uses high-energy radiation to reduce a tumor’s size, prevent it from growing or treat bladder cancer symptoms.

If you don’t want or can’t have a cystectomy, you may receive radiation therapy instead. This treatment is also used in combination with TURBT or chemotherapy to treat bladder cancer more effectively.

The board-certified radiation oncologists at Beaufort Memorial perform external beam radiation therapy, which is most often used to treat bladder cancer. The treatment directs radiation beams from a source outside the body to the tumor with extreme accuracy, minimizing damage to surrounding healthy tissue.

Follow-up Care

After your treatment, your urologist and oncology team will monitor you for recurrence. If they removed your tumor successfully, you will likely need follow-up visits every three to six months.

During these visits, your doctor will ask about your symptoms and might order tests that screen for bladder cancer.

Your nurse navigator will help you develop a survivorship plan and provide you with resources to manage your diagnosis. Beaufort Memorial offers many cancer support services — from education to support groups — including a social worker who can help guide you through recovery.