Treatment Options for Bladder Cancer

The treatment of bladder cancer typically involves some form of surgery. This approach aims to remove as much of the cancer as possible.

There are a few different types of bladder cancer surgery:

• Transurethral resection: A transurethral resection involves insertion of a small, thin tool into the bladder in order to remove the cancer. It’s typically used for earlier stage bladder cancers.
• Partial cystectomy: A partial cystectomy removes only the area of the bladder where the cancer is. It may be used for tumors that are only found in one part of the bladder and cannot be removed by transurethral resection.
• Radical cystectomy: A radical cystectomy is the removal of the entire bladder. This is typically done when bladder cancer affects multiple areas of the bladder or has invaded the muscle tissue of the bladder.

If the cancer has spread beyond the bladder, it’s also possible that lymph nodes or other pelvic organs may be removed during bladder cancer surgery. This is typically done during a radical cystectomy.

Radiation therapy uses high energy radiation to kill cancer cells or slow their growth. In bladder cancer, this type of treatment is given as external-beam radiation, which uses a machine to carefully direct the radiation at the cancer.

Radiation therapy may be used after surgery to remove any remaining cancer cells. It’s also a potential option for people who can’t have surgery or chemotherapy. Lastly, it may be used as a part of treatment for advanced bladder cancer.

Chemotherapy uses drugs that affect the growth and division of cells. Because cancer cells grow and divide more quickly than many other types of cells, chemotherapy can kill them or reduce their growth.

There are two types of chemotherapy for bladder cancer:

• Intravesical: Intravesical chemotherapy is given directly into the bladder via a catheter. It’s used for very early stage bladder cancers, typically after transurethral resection.
• Systemic: Systemic chemotherapy for bladder cancer is given via IV. It may be used before surgery to help shrink a tumor or after surgery to get rid of any remaining cancer cells. Systemic chemotherapy is also used for advanced bladder cancers.

Immunotherapy is a type of cancer treatment that aims to boost your immune system’s response to cancer. There are a few different types of immunotherapy for bladder cancer.

In BCG immunotherapy, a type of bacteria called BCG is introduced directly to the bladder via a catheter. This helps to stimulate an immune response to the cancer. It’s typically used for early stage bladder cancers that haven’t invaded the bladder muscle tissue.

Immune checkpoint inhibitors work by switching off one of the mechanisms that keeps the immune system from attacking cells in the body. They include drugs like nivolumab (Opdivo) and pembrolizumab (Keytruda) and may be used:

• to prevent cancer from coming back after surgery
• when other treatments haven’t been effective or aren’t recommended
• if cancer has come back after treatment (recurred)

Monoclonal antibodies bind to certain parts of cancer cells. Those used for bladder cancer deliver chemotherapy drugs directly to cancer cells. They may be used when other treatments haven’t been effective or aren’t recommended.

Targeted therapy is a type of treatment that’s directed specifically at different markers associated with cancer cells. While some treatments, such as chemotherapy, have broad effects, this treatment hones in on cancer cells.

Monoclonal antibodies, such as those discussed above, are a type of targeted therapy. Another type of targeted therapy drug for bladder cancer is called erdafitinib (Balversa), which blocks an enzyme that helps bladder cancer cells grow.

Targeted therapy is used for more advanced bladder cancers. It may also be recommended when bladder cancer has recurred.

Doctors and scientists continue to develop newer, more effective treatments for bladder cancer. These can include things like newer combinations of existing therapies or completely new treatments. Let’s look at a few examples.

About 25% to 45% of people don’t respond to BCG. As such, researchers are working on ways to improve BCG treatment. One 2022 trial looked at combining BCG with an immune-stimulating drug called N-803 in people who didn’t respond to BCG.

At a 2-year follow-up this treatment led to a 99% bladder cancer-specific overall survival. Additionally, over 90% of participants avoided having a cystectomy in this time period.

Another 2022 trial looked at using chemotherapy after transurethral resection instead of BCG. Researchers explored this option due to a BCG shortage that was present even before the COVID-19 pandemic.

After 24 months, recurrence-free survival was 82% and overall survival was 84%. None of the study participants died from bladder cancer during the study period. In a statement, the researchers noted that their results were similar to those seen with BCG.

Bladder cancer treatment can be expensive. A 2021 study estimated that the total median costs of one year of BCG therapy for bladder cancer were $29,459.

Generally speaking, health insurance will cover at least some costs of treatments that are considered medically necessary for a health condition like bladder cancer.

Nevertheless, it’s important to check in with your insurance company before starting your treatment. That way, you’ll have a better idea of what’s covered and what you’ll be responsible for paying for yourself.

It’s also possible that bladder cancer treatment may be less expensive abroad. Traveling in order to receive medical treatment is sometimes called medical tourism.

If you’re interested in this route, the Centers for Disease Control and Prevention (CDC) provides some tips for how to engage in medical tourism safely:

• Be very thorough about checking the qualifications of the healthcare professionals that you’d be seeing as well as the credentials of the facilities where you plan to receive treatment.
• Consider the language of the country where you’ll be traveling to and have a plan on how you will communicate with healthcare professionals and staff.
• Consult with your doctor 4 to 6 weeks before your trip to discuss general health information and any risks that you may be facing.
• Bring copies of all of your medical records related to your condition.
• Obtain a travel health insurance policy before leaving for your treatment.

The overall outlook for bladder cancer depends on many factors, such as:

• the specific type of bladder cancer
• the stage of the cancer at diagnosis
• how the cancer responds to treatment
• whether the cancer spreads (metastasizes) to other areas of the body
• if the cancer comes back after treatment
• your age and overall health

Outlook for people with cancer is often estimated as a 5-year survival rate. This is the percentage of people with a certain type and stage of cancer that are alive 5 years after their diagnosis.

According to the SEER database of the National Cancer Institute, the 5-year survival rates for bladder cancer are:

These estimates are based on data from many people with bladder cancer over a long span of years. They don’t reflect recent advances in treatment or individual factors. As such, always discuss your individual outlook with your care team.

Are most bladder cancers curable?

According to the American Cancer Society (ACS), the earliest stages of bladder cancer (stage 0, or in situ) are curable with treatment. Other types of bladder cancer are more challenging to cure.

However, many bladder cancers are diagnosed in this early stage. The SEER database notes that 51% of bladder cancers are diagnosed at the in situ stage.

How common is bladder cancer?

The ACS, which groups their population estimates into men and women, notes that bladder cancer is the fourth most common cancer in men. This cancer isn’t as common in women.

It’s estimated that there will be 81,180 new diagnoses of bladder cancer in the United States in 2022. About 61,700 of these diagnoses will be in men and 19,480 in women.

What causes bladder cancer?

Bladder cancer happens when cells in the bladder acquire changes that cause them to grow and divide out of control. While it’s unknown what exactly causes bladder cancer, some examples of known risk factors are:

• being 55 or older
• being assigned male at birth
• having a personal or family history of bladder cancer
• experiencing repeated bladder infections or kidney stones
• smoking
• having a urinary catheter in for a long time
• receiving radiation therapy to the pelvis or having certain types of chemotherapy
• experiencing occupational exposures to certain chemicals

What are the symptoms of bladder cancer?

Potential symptoms of bladder cancer can include:

• blood in your urine
• urinating more frequently
• painful or burning sensations while urinating
• weak urine stream or difficulty urinating
• back pain

Can bladder cancer be prevented?

There’s no definite way to prevent bladder cancer. However, you can do the following to reduce your risk:

• If you smoke, consider quitting smoking.
• Take steps to reduce your exposure to potentially harmful chemicals in the workplace.
• Make sure to drink enough fluids, especially water.
• Seek timely care for any urinary tract issues, such as infections or kidney stones.

There are many different treatment options for bladder cancer. The specific type of treatment that’s recommended for you will depend on things like your cancer’s stage and grade as well as your age and overall health.

Most bladder cancer treatment plans involve some type of surgery. Other treatments, such as chemotherapy, radiation therapy, and immunotherapy may be used in addition to this.

The outlook for bladder cancer is best when it’s diagnosed early. If you’ve recently received a diagnosis of bladder cancer, have an open discussion with your care team about your individual outlook and what to expect from treatment.