Treating Bladder Cancer

cancer.org | 1.800.227.
2345
Treating Bladder Cancer

If you’ve been diagnosed with bladder cancer, your treatment team will discuss your
options with you. It’s important to weigh the benefits of each treatment option against
the possible risks and side effects.
How is bladder cancer treated?
Depending on the stage of the cancer and other factors, treatment options for people
with bladder cancer can include:
● Bladder Cancer Surgery

● Intravesical Therapy for Bladder Cancer
● Chemotherapy for Bladder Cancer
● Radiation Therapy for Bladder Cancer
● Immunotherapy for Bladder Cancer
● Targeted Therapy Drugs for Bladder Cancer
Common treatment approaches
Many times, the best option might include more than one of type of treatment. Surgery,
alone or with other treatments, is used to treat most bladder cancers. Early-stage
bladder tumors can often be removed. But a major concern in people with early-stage
bladder cancer is that new cancers often form in other parts of the bladder over time.
Taking out the entire bladder (called radical cystectomy) is one way to avoid this, but it
causes major side effects. If the entire bladder is not removed, other treatments may be
used to try to reduce the risk of new cancers. Whether or not other treatments are
given, close follow-up is needed to watch for signs of new cancers in the bladder.
● Treatment of Bladder Cancer, by Stage
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Who treats bladder cancer?
Based on your treatment options, you might have different types of doctors on your
treatment team. These doctors could include:
● Urologists: surgeons who specialize in treating diseases of the urinary system and
male reproductive system
● Radiation oncologists: doctors who treat cancer with radiation therapy
● Medical oncologists: doctors who treat cancer with medicines such as
chemotherapy and immunotherapy
You might have many other specialists on your treatment team as well, including
physician assistants, nurse practitioners, nurses, nutrition specialists, social workers,
and other health professionals.
● Health Professionals Associated With Cancer Care
Making treatment decisions
It’s important to discuss all of your treatment options, including their goals and possible
side effects, with your doctors to help make the decision that best fits your needs. Some
important things to consider include:
● Your age and expected life span

● Any other serious health conditions you have
● The stage and grade of your cancer
● The likelihood that treatment will cure your cancer (or help in some other way)
● Your feelings about the possible side effects from treatment
You may feel that you must make a decision quickly, but it’s important to give yourself
time to absorb the information you have just learned. It’s also very important to ask
questions if there is anything you’re not sure about.
If time permits, it is often a good idea to seek a second opinion. A second opinion can
give you more information and help you feel more confident about the treatment plan
you choose.
● Questions To Ask About Bladder Cancer

● Seeking a Second Opinion
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Help getting through cancer treatment
People with cancer need support and information, no matter what stage of illness they
may be in. Knowing all of your options and finding the resources you need will help you
make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all,
you can still get supportive care to help with pain or other symptoms. Communicating
with your cancer care team is important so you understand your diagnosis, what
treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an
important part of your care. These might include nursing or social work services,
financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services – including rides to
treatment, lodging, and more – to help you get through treatment. Call our National
Cancer Information Center at 1-800-227-2345 and speak with one of our trained
specialists.
● Palliative Care
● Find Support Programs and Services in Your Area
Choosing to stop treatment or choosing no treatment at all
For some people, when treatments have been tried and are no longer controlling the
cancer, it could be time to weigh the benefits and risks of continuing to try new
treatments. Whether or not you continue treatment, there are still things you can do to
help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all.
There are many reasons you might decide not to get cancer treatment, but it’s important
to talk to your doctors and you make that decision. Remember that even if you choose
not to treat the cancer, you can still get supportive care to help with pain or other
symptoms.
● If Cancer Treatments Stop Working
The treatment information given here is not official policy of the American Cancer
Society and is not intended as medical advice to replace the expertise and judgment of
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your cancer care team. It is intended to help you and your family make informed
decisions, together with your doctor. Your doctor may have reasons for suggesting a
treatment plan different from these general treatment options. Don't hesitate to ask him
or her questions about your treatment options.
Bladder Cancer Surgery

Surgery is part of the treatment for most bladder cancers . The type of surgery done
depends on the stage (extent) of the cancer. It also depends on your choices based on
the long-term side effects of some kinds of surgery.
Transurethral resection of bladder tumor (TURBT)
A transurethral resection of bladder tumor (TURBT) or a transurethral resection (TUR) is

often used to find out if someone has bladder cancer and, if so, whether the cancer has
spread into (invaded) the muscle layer of the bladder wall.
TURBT is also the most common treatment for early-stage or superficial (non-muscle
invasive) bladder cancers. Most patients have superficial cancer when they're first
diagnosed, so this is usually their first treatment. Sometimes, a second, more extensive
TURBT is done to better ensure that all the cancer has been removed. The goal is to
take out the cancer cells and nearby tissues down to the muscle layer of the bladder
wall.
How TURBT is done
This surgery is done using an instrument put in through your urethra, so it there's no
cutting into the abdomen (belly). You'll get either general anesthesia (drugs are used to
make you sleep) or regional anesthesia (the lower part of your body is numbed).
A type of thin, rigid cystoscope called a resectoscopeis put into your bladder through
your urethra. The resectoscope has a wire loop at the end that's used to remove any
abnormal tissues or tumors. The removed tissue is sent to a lab for testing.
After the tumor is removed, more steps may be taken to try to ensure that the cancer
has been completely destroyed. For instance, the tissue in the area where the tumor
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was may be burned while looking at it with the resectoscope. This is called fulguration.
Cancer cells can also be destroyed using a high-energy laser through the resectoscope.
Possible side effects
The side effects of TURBT are generally mild and don't usually last long. Right after
TURBT you might have some bleeding and pain when you urinate. You can usually go
home the same day or the next day and can return to your usual activities within a week
or two.
Even if the TURBT removes the tumor completely, bladder cancer often comes back
(recurs) in other parts of the bladder. This might be treated with another TURBT. But if
TURBT needs to be repeated many times, the bladder can become scarred and not be
able to hold much urine. This can lead to side effects like frequent urination, or even
incontinence (loss of control of urine).
In patients with a long history of recurrent, non-invasive low-grade tumors (slow-growing

tumors that keep coming back), the surgeon may just use fulguration to burn small
tumors that are seen during cystoscopy (rather than removing them). This can often be
done using local anesthesia (numbing medicine) in the doctor’s office. It's safe but can
be mildly uncomfortable.
Cystectomy
When bladder cancer is invasive, all or part of the bladder may need to be removed.
This operation is called a cystectomy. Most of the time, chemotherapy is given before
cystectomy is done. General anesthesia (where you are in a deep sleep) is used for
either type of cystectomy.
Partial cystectomy
If the cancer has invaded the muscle layer of the bladder wall but is not very large and
is only in one place, it can sometimes be removed along with part of the bladder wall
without taking out the whole bladder. The hole in the bladder wall is then closed with
stitches. Nearby lymph nodes are also removed and tested for cancer spread. Only a
small portion of people with cancer that has invaded the muscle can have this surgery.
The main advantage of this surgery is that the person keeps their bladder and doesn’t
need reconstructive surgery (see below). But the remaining bladder may not hold as
much urine, which means they'll have to urinate more often. With this type of surgery,
the main concern is that bladder cancer can still come back (recur) in another part of the
bladder wall.
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Radical cystectomy
If the cancer is larger or is in more than one part of the bladder, a radical cystectomy will
be needed. This operation removes the entire bladder and nearby lymph nodes. In men,
the prostate and seminal vesicles are also removed. In women, the ovaries, fallopian
tubes (tubes that connect the ovaries and uterus), the uterus (womb), cervix, and a
small part of the vagina are removed too.
Most of the time, cystectomy is done through a cut (incision) in the belly (abdomen).
You'll need to stay in the hospital for about a week after the surgery. You can usually go
back to your normal activities after several weeks.
In some cases, the surgeon may operate through many smaller incisions using special
long, thin instruments, one of which has a tiny video camera on the end to see inside
your body. This is called laparoscopic, or “keyhole” surgery. The surgeon may either
hold the instruments directly or may sit at a control panel in the operating room and use
robotic arms to do the surgery (sometimes known as a robotic cystectomy). This type
of surgery may result in less pain and quicker recovery because of the smaller cuts. But
it hasn’t been around as long as the standard type of surgery, so it’s not yet clear if it
works as well.
It's important that any type of cystectomy be done by a surgeon with experience in
treating bladder cancer. If the surgery is not done well, the cancer is more likely to come
back.
Reconstructive surgery after radical cystectomy
If your whole bladder is removed, you'll need another way to store urine and pass it out
of your body. Several types of reconstructive surgery can be done.
Incontinent diversion
One option may be to remove and clean a short piece of your intestine and then
connect it to the ureters (the tubes that carry urine out of the kidneys). This creates a
passageway, known as an ileal conduit, for urine to pass from the kidneys to the
outside of the body. Urine flows from the kidneys through the ureters into the ileal
conduit. One end of the conduit is connected to the skin on the front of the belly
(abdomen) by an opening called a stoma. (This is also called a urostomy1. )
After this procedure, a small bag sticks to the skin of your belly around the stoma to
collect the urine. Urine slowly drains out non-stop, so the bag must be on all the time.
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It's emptied whenever it's full. This is called an incontinent diversion, because you
cannot control the flow of urine out of your body.
Continent diversion
Another way for urine to drain is a continent diversion. A pouch is made from a piece of
intestine that's attached to the ureters. One end of the pouch is connected to an
opening (stoma) in your skin on the front of your belly. A one-way valve is created at
this opening. This allows urine to be stored in the pouch. You then empty it several
times a day by putting a thin drainage tube (catheter) into the stoma through the valve.
Some people prefer this method because there's no bag on the outside.
Neobladder
This method routes the urine back into the urethra, so you pass urine the same way. To
do this, the surgeon creates a new bladder (neobladder) from a piece of intestine. As
with the incontinent and continent diversions, the ureters are connected to the
neobladder. The difference is that the neobladder is also sewn to the urethra. This lets
you urinate normally on a schedule. (You won't have the urge to urinate, so a schedule
is needed.) Over time, most people regain the ability to urinate normally during the day,
but incontinence at night may be a problem.
If the cancer has spread or can’t be removed with surgery, a diversion may be made
without taking out the bladder. In this case, the purpose of the surgery is to prevent or
relieve blockage of urine flow, rather than try to cure the cancer.
Risks and side effects of cystectomy
The risks with any type of cystectomy are much like those with any major surgery.
Problems during or shortly after surgery can include:
● Reactions to anesthesia
● Bleeding
● Blood clots in the legs or lungs
● Damage to nearby organs
● Infection
Most people will have at least some pain after the operation, which can be controlled
with pain medicines.
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Effects of cystectomy on urination
Bladder surgery can affect how you pass urine. If you have had a partial cystectomy,
this might be limited to having to go more often (because your bladder can’t hold as
much urine).
If you have a radical cystectomy, you'll need reconstructive surgery (described above)
to create a new way for urine to leave your body. Depending on the type of
reconstruction, you might need to learn how to empty your urostomy bag or put a
catheter into your stoma. Aside from these changes, urinary diversion and urostomy can
also lead to:
● Infections
● Urine leaks
● Incontinence
● Pouch stones
● Blockage of urine flow
● Absorption problems (depends on the amount of intestine that was used)
The physical changes that come from removing the bladder and having a urostomy can
affect your quality of life, too. Discuss your feelings and concerns with your health care
team.
To learn a lot more about urostomies, see Urostomy Guide2.
Sexual effects of radical cystectomy in men
Radical cystectomy removes the prostate gland and seminal vesicles. Since these
glands make most of the seminal fluid, removing them means that a man will no longer
make semen. He can still have an orgasm, but it will be “dry.”
After surgery, many men have nerve damage that affects their ability to have erections.
In some men this may improve over time. For the most part, the younger a man is, the
more likely he is to regain the ability to have full erections. If this issue is important to
you, discuss it with your doctor before surgery. Newer surgical techniques may help
lower the chance of erection problems.
For more on sexual issues and ways to cope with them, see Sex and the Man With
Cancer.3
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Sexual effects of radical cystectomy in women
This surgery often removes the front part of the vagina. This can make sex less
comfortable for some women, though most of the time it's still possible. One option is to
have the vagina rebuilt (called vaginal reconstruction). There's more than one way to do
this, so talk with your surgeon about the pros and cons of each method. Whether or not
you have reconstruction, there are many ways to make sex more comfortable.
Radical cystectomy can also affect a woman’s ability to have an orgasm if the nerve
bundles that run along each side of the vagina are damaged. Talk with your doctor
about whether these nerves can be left in place during surgery.
If the surgeon takes out the end of the urethra where it opens outside the body, the
clitoris can lose some of its blood supply, which might affect sexual arousal. Talk with
your surgeon about whether the end of the urethra can be spared.
For more on ways to cope with these and other sexual issues, see Sex and the Woman
With Cancer4.
Sexual effects of urostomy
It’s normal for both men and women to be concerned about having a sex life with a
urostomy. Having your ostomy pouch fit correctly and emptying it before sex reduces
the chances of a major leak. A pouch cover or small ostomy pouch can be worn with a
sash to keep the pouch out of the way. Wearing a snug fitting shirt may be more
comfortable. Choose sexual positions that keep your partner’s weight from rubbing
against the pouch. For more tips, see Urostomy Guide5.
More information about Surgery
For more general information about surgery as a treatment for cancer, see Cancer
Surgery6.
To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects7.
Hyperlinks
1. www.cancer.org/treatment/treatments-and-side-effects/treatment-
types/surgery/ostomies/urostomy.html
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3. www.cancer.org/treatment/treatments-and-side-effects/physical-side-
effects/fertility-and-sexual-side-effects/sexuality-for-men-with-cancer.html
4. www.cancer.org/treatment/treatments-and-side-effects/physical-side-
effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer.html
types/surgery.html
7. www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects.html
References
American Society of Clinical Oncology. Bladder Cancer: Treatment Options. 10/2017.

Accessed at www.cancer.net/cancer-types/bladder-cancer/treatment-options on
January 16, 2019.
Cattaneo F, Motterle G, Zattoni F, Morlacco A, Dal Moro F. The Role of Lymph Node
Dissection in the Treatment of Bladder Cancer. Front Surg. 2018;5:62.
Crabb SJ, Douglas J. The latest treatment options for bladder cancer. Br Med Bull. 2018
Oct 29.
Encyclopedia of Surgery. Cystectomy. Accessed at www.surgeryencyclopedia.com/Ce-

Fi/Cystectomy.html on January 16, 2019
National Cancer Institute. Bladder Cancer Treatment (PDQ®)–Health Professional

Version. November 16, 2018. Accessed at www.cancer.gov/types/bladder/hp/bladder-
treatment-pdq on January 16, 2019.
National Cancer Institute. Bladder Cancer Treatment (PDQ®)–Patient Version. October

19, 2018. Accessed at www.cancer.gov/types/bladder/patient/bladder-treatment-pdq on
January 16, 2019.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology

(NCCN Guidelines®), Bladder Cancer, Version 5.2018 -- July 3, 2018. Accessed at
www.nccn.org/professionals/physician_gls/pdf/bladder.pdf on January 16, 2019.
See all references for Bladder Cancer (www.cancer.org/cancer/bladder-
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cancer/references.html)
Last Medical Review: January 30, 2019 Last Revised: January 30, 2019
Intravesical Therapy for Bladder Cancer

With intravesical therapy, the doctor puts a liquid drug right into your bladder rather than
giving it by mouth or injecting it into your blood. The drug is put in through a soft
catheter that's put into your bladder through your urethra. The drug stays in your
bladder for up to 2 hours. This way, the drug can affect the cells lining the inside of your
bladder without having major effects on other parts of your body.
When is intravesical therapy used?
After TURBT
Intravesical therapy is commonly used after transurethral resection of bladder tumor

(TURBT). It's often done within 24 hours of the TURBT procedure. Some experts say it
should be done within 6 hours. The goal is to kill any cancer cells that may be left in the
bladder.
To treat non-invasive bladder cancer
These cancers are only in the lining of the bladder. They may be called non-invasive
(stage 0), or minimally invasive (stage I) bladder cancers. They have not spread into
deeper layers on the bladder wall muscles or to other parts of the body. Intravesical
chemotherapy is used for these early-stage cancers because drugs given this way
mainly affect the cells lining the inside of the bladder. They have little to no effect on
cells elsewhere. This means that any cancer cells outside of the bladder lining, including
those that have grown deeply into the bladder wall, are not treated by intravesical
therapy. Drugs put into the bladder also can’t reach cancer cells in the kidneys, ureters,
and urethra, or those that have spread to other parts of the body.
One dose of intravesical chemotherapy might be the only treatment needed for non-
invasive cancers.
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Low-risk non-invasive (low-grade) bladder cancers grow slowly. They may be treated
with 1 dose of intravesical chemo after TURBT. It's used to help keep the cancer from
coming back.
Intravesical chemotherapy or immunotherapy may used for intermediate non-invasive

bladder cancers. Some studies suggest that immunotherapy works best. It's done once
a week for 6 weeks, and may be repeated for another 6 weeks if needed. This is called
induction therapy. After a 4- to 6-week break, maintenance treatments are then done for
at least 1 year.
High-risk non-invasive bladder cancers might be fast-growing (high-grade), big, or there

may be more than 1 tumor. They're treated with induction intravesical immunotherapy. If
there's a good response to induction therapy, it's followed by 3 years of maintenance
intravesical immunotherapy.
Intravesical immunotherapy maintenance treatment schedules vary. For instance,

treatment may be done for 3 to 6 weeks every month, every 3 months, or twice a year. It
can be done for 1 to 3 years. Your doctor will talk with you about the best plan based on
the details of your bladder cancer and how it responds to treatment.
To treat higher-stage, invasive bladder cancers
One dose of intravesical chemotherapy is done within 24 hours of TURBT. But other
types of treatment are usually the next steps for Stage II to IV (2 to 4) bladder cancers
because they have spread beyond the lining layer of the bladder wall.
Sometimes induction and maintenance intravesical immunotherapy is used after

radiation and systemic (in the blood) chemo for stage II cancers if surgery can't be
done. It's seldom used for stage III. When it is, it's used along with other treatments in
cases where surgery can't be done. Stage IV bladder cancers are rarely treated with
intravesical therapy.
Types of intravesical therapy
There are 2 types of intravesical therapy:
● Immunotherapy
● Chemotherapy
Intravesical immunotherapy
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Immunotherapy causes the body’s own immune system to attack the cancer cells.
Bacillus Calmette-Guerin or BCG is the most common intravesical immunotherapy for

treating early-stage bladder cancer. It's used to help keep the cancer from growing and
to help keep it from coming back.
BCG is a germ that's related to the one that causes tuberculosis (TB), but it doesn’t
usually cause serious disease. BCG is put right into the bladder through a catheter. It
reaches the cancer cells and "turns on" the immune system. The immune system cells
are attracted to the bladder and attack the bladder cancer cells. BCG must come in
contact with the cancer cells to work. This is why it's used for intravesical therapy.
Treatment with BCG can cause a wide range of symptoms. It's common to have flu-like
symptoms, such as fever, achiness, chills, and fatigue. These can last for 2 to 3 days
after treatment. It also commonly causes a burning feeling in the bladder, the need to
urinate often, and even blood in the urine. Rarely, BCG can spread into the blood and
through the body, leading to a serious infection. This can happen even years after
treatment. One sign of this can be a high fever that isn’t helped by Tylenol or medicines
like it. If this happens, call your doctor right away. You might want to ask about other
serious side effects you should watch for and call your doctor about.
Intravesical chemotherapy
For this treatment, chemotherapy (chemo) drugs are put right into the bladder through a
catheter. These drugs kill actively growing cancer cells. Many of these same drugs can
also be given systemically (usually into a vein) to treat more advanced stages of bladder
cancer. Intravesical chemotherapy is most often used when intravesical immunotherapy
doesn't work. It's seldom used for more than 1 year.
The chemotherapy solution might be heated up before it's put into the bladder. Some
experts believe that this makes the drug work better and helps it get into the cancer
cells. When the chemo is heated, it might be called hyperthermic intravesical therapy.
Mitomycin is the drug used most often for intravesical chemotherapy. Delivery of
mitomycin into the bladder along with heating the inside of the bladder, a treatment
called electromotive mitomycin therapy, may work even better than giving
intravesical mitomycin the usual way.
Gemcitabine may cause fewer side effects than mitomycin and is less likely to be
absorbed into the blood.
Valrubicin might be used if BCG stops working. But not all experts agree on this
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treatment.
The main side effects of intravesical chemo are irritation and a burning feeling in the
bladder, and blood in the urine.
A major advantage of giving chemo right into the bladder instead of injecting it into the
bloodstream is that the drugs usually do not reach and effect other parts of the body.
This helps people avoid many of the side effects linked to chemo.
References
American Urological Association. Intravesical Administration of Therapeutic Medication.

Jointly developed with the Society of Urologic Nurses and Associates (SUNA).
Accessed at www.auanet.org/guidelines/intravesical-administration-of-therapeutic-
medication on January 16, 2019.
de Jong JJ, Hendricksen K, Rosier M, Mostafid H, Boormans JL. Hyperthermic

Intravesical Chemotherapy for BCG Unresponsive Non-Muscle Invasive Bladder Cancer
Patients. Bladder Cancer. 2018;4(4):395-401.
Green DB, Kawashima A, Menias CO, et al. Complications of Intravesical BCG

Immunotherapy for Bladder Cancer. Radiographics. 2019;39(1):80-94.
Manikandan R, Rodriguez O, Parada R, Palou Redorta J. Nonmuscle-invasive bladder

cancer: what's changing and what has changed. Urologia. 2017;84(1):1-8.

Peyton CC, Chipollini J, Azizi M, et al. Updates on the use of intravesical therapies for
non-muscle invasive bladder cancer: how, when and what. World J Urol. 2018 Dec 7.
Porten SP, Leapman MS, Greene KL. Intravesical chemotherapy in non-muscle-

invasive bladder cancer. Indian J Urol. 2015;31(4):297–303.
Werntz RP, Adamic B, Steinberg GD. Emerging therapies in the management of high-
risk non-muscle invasive bladder cancer (HRNMIBC). World J Urol. 2018 Dec 4.
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Chemotherapy for Bladder Cancer

Chemotherapy (chemo) is the use of drugs to treat cancer. Chemo for bladder cancer
can be given in 2 different ways:
Intravesical chemotherapy
For this treatment, the chemo drug is put right into the bladder. This type of chemo is
used for bladder cancer that's only in the lining of the bladder. It's described in
Intravesical Therapy for Bladder Cancer.
Systemic chemotherapy
When chemo drugs are given in pill form or injected into a vein (IV) or muscle (IM), the
drugs go into the bloodstream and travel throughout the body. This is called systemic
chemotherapy. Systemic chemo can affect cancer cells anywhere in the body.
When is chemotherapy used?
Systemic chemo can be used :
● Before surgery to try to shrink a tumor so that it's easier to remove and to help
lower the chance the cancer will come back. Giving chemo before surgery is called
neoadjuvant therapy.
● After surgery (or sometimes after radiation therapy). This is called adjuvant
therapy. The goal of adjuvant therapy is to kill any cancer cells that may remain
after other treatments. This can lower the chance that the cancer will come back
later.
● In people getting radiation therapy, to help the radiation work better.
● As the main treatment for bladder cancers that have spread to distant parts of the
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body.
Which chemo drugs are used to treat bladder cancer?
Chemo drugs may be used alone or in combination, depending on what they’re being
used for, a person’s overall health, and other factors.
When chemo is given with radiation, the most common drugs used include:
● Cisplatin
● Cisplatin plus fluorouracil (5-FU)
● Mitomycin with 5-FU
When chemo is used without radiation, the most common combinations include:
● Gemcitabine and cisplatin

● Dose-dense methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin
(DDMVAC)
● Cisplatin, methotrexate, and vinblastine (CMV)
● Gemcitabine and paclitaxel
For some people, the side effects of getting more than one chemo drug might be too
much to handle. For those people, treatment with a single drug, such as gemcitabine or
cisplatin, may be an option. Other drugs sometimes used alone for bladder cancer
include, docetaxel, paclitaxel, doxorubicin, methotrexate, ifosfamide, and pemetrexed.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to
allow the body time to recover. Each cycle typically lasts for a few weeks.
Most bladder cancers are transitional cell (urothelial) cancers, but there are other types
as well, including squamous cell carcinoma, adenocarcinoma, and small cell carcinoma.
These rare types of bladder cancer may be treated with drugs different from those listed
above.
Side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against
cancer cells. But other cells in the body, such as those in the bone marrow (where new
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blood cells are made), the lining of the mouth and intestines, and the hair follicles, also
divide quickly. These cells are also likely to be affected by chemo, which can lead to
side effects.
The side effects of chemo depend on the type and dose of drugs given and how long
they are taken. When chemo and radiation are given at the same time, side effects tend
to be worse. Common side effects of chemo include:
● Nausea and vomiting

● Loss of appetite
● Hair loss
● Mouth sores
● Diarrhea
● Constipation
● Increased risk of infections (because of a shortage of white blood cells)
● Easy bleeding or bruising, even after minor cuts or injuries (due to a shortage of
blood platelets)
● Fatigue (because of a shortage of red blood cells)
These side effects usually go away over time after treatment ends. There are often
ways to lessen these side effects, some can even be prevented. For instance, drugs
can be used to help prevent or reduce nausea and vomiting. Ask your health care team
about the side effects your chemo drugs may cause and what can be done to prevent
and/or treat them.
Some chemo drugs can cause other, less common side effects. For example, drugs like
cisplatin, docetaxel, and paclitaxel can damage nerves. This can sometimes lead to
symptoms (mainly in the hands and feet) such as pain, burning or tingling, sensitivity to
cold or heat, or weakness. This is called peripheral neuropathy.
Be sure to report any side effects to your medical team so that they can be treated right
away. In some cases, the doses of the chemo drugs may need to be reduced or
treatment may need to be delayed or stopped to keep side effects from getting worse.
More information about chemotherapy
For more general information about how chemotherapy is used to treat cancer,
see Chemotherapy1.
To learn about some of the side effects listed here and how to manage them, see
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Managing Cancer-related Side Effects2.
Hyperlinks
types/chemotherapy.html
References

January 18, 2019.
Del Bene G, Calabrò F, Giannarelli D, et al. Neoadjuvant vs. Adjuvant Chemotherapy in

Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database. Front
Oncol. 2018;8:463.


Radiation Therapy for Bladder Cancer

Radiation therapy uses high-energy radiation to kill cancer cells.
When is radiation therapy used?
Radiation therapy can be used:
18
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● As part of the treatment for some early-stage bladder cancers , after surgery that
doesn’t remove the whole bladder (such as TURBT)
● As the main treatment for people with earlier-stage cancers who can’t have surgery
or chemotherapy
● To try to avoid cystectomy (surgery to take out the bladder)
● As part of treatment for advanced bladder cancer (cancer that has spread beyond
the bladder)
● To help prevent or treat symptoms caused by advanced bladder cancer
Radiation therapy is often given along with chemotherapy to help the radiation work
better. This is called chemoradiation.
How is radiation therapy given?
The type of radiation most often used to treat bladder cancer is called external beam
radiation therapy. It focuses radiation from a source outside of the body on the cancer.
Before your treatments start, your radiation team will take careful measurements to find
the exact angles for aiming the radiation beams and the proper dose of radiation. This
planning session, called simulation, usually includes getting imaging tests such as CT
or MRI scans. This helps the doctor map where the tumor is in your body. You'll be
asked to empty your bladder before simulation and before each treatment.
The treatment is a lot like getting an x-ray, but the radiation is stronger. Radiation
doesn't hurt. Each treatment lasts only a few minutes, but the setup time – getting you
into place for treatment – usually takes longer. Most often, radiation treatments are
given 5 days a week for many weeks.
Possible side effects of radiation therapy
Side effects of radiation depend on the dose given and the area being treated. They
tend to be worse when chemo is given along with radiation. They can include:
● Skin changes in areas getting radiation, ranging from redness to blistering and
peeling
● Nausea and vomiting
● Bladder symptoms, like burning or pain when you urinate, feeling the need to go
often, or blood in your urine
● Diarrhea
19
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● Blood in stool and/or urine

● Tiredness (fatigue)
● Low blood counts, which can lead to fatigue, easy bruising or bleeding, or
increased risk of infection
These effects usually go away over time after treatment, but some people can have
longer-term problems. For instance:
● In some people radiation treatments can lead to incontinence (problems holding

urine) later on.
● Radiation can damage the lining of the bladder. This is called radiation cystitis
and can cause long-term problems such as blood in the urine or painful urination.
● Nearby nerves and blood vessels might be damaged, leading to erection problems
in men.
If you have side effects from radiation therapy, talk to with your health care team. They
can suggest ways to ease many of them.
More information about radiation therapy
To learn more about how radiation is used to treat cancer, see Radiation Therapy1.
Hyperlinks
types/radiation.html
References

January 18, 2019.
Crabb SJ, Douglas J. The latest treatment options for bladder cancer. Br Med Bull. 2018
20
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Oct 29.


Immunotherapy for Bladder Cancer

Immunotherapy is the use of medicines to help a person’s own immune system
recognize and destroy cancer cells. Ths type of treatment is sometimes used to treat
bladder cancer.
Intravesical BCG
BCG is a type of bacteria related to the one that causes tuberculosis. While it doesn’t
usually cause a person to get sick, it can help trigger an immune response. BCG can be
put right into the bladder as a liquid. This activates immune system cells in the bladder,
which then attack bladder cancer cells.
For more details on this treatment, see Intravesical Therapy for Bladder Cancer.
Immune checkpoint inhibitors
An important part of the immune system is its ability to keep itself from attacking normal
cells in the body. To do this, it uses “checkpoints” – proteins on immune cells that need
to be turned on (or off) to start an immune response.
Cancer cells sometimes use these checkpoints to keep from being attacked by the
immune system. But newer drugs that target these checkpoints, called checkpoint
inhibitors, can help restore the immune response against cancer cells.
21
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PD-1 and PD-L1 inhibitors
Atezolizumab (Tecentriq), durvalumab (Imfinzi), and avelumab (Bavencio) are

drugs that target PD-L1, a protein on cells (including some cancer cells) that helps keep
the immune system from attacking them. By blocking PD-L1, these drugs boost the
immune system's response against the cancer cells. This can shrink some tumors or
slow their growth.
Nivolumab (Opdivo) and pembrolizumab (Keytruda) target PD-1, a protein on certain

immune cells (called T cells) that normally helps keep these cells from attacking other
cells in the body. Blocking PD-1 can allow the immune system to attack the cancer
cells, which can shrink some tumors or slow their growth.
These drugs can be used in different situations to treat bladder cancer:
● Any of these checkpoint inhibitors can be used in people with advanced bladder
cancer that starts growing again after chemotherapy.
● Atezolizumab and pembrolizumab can be used in people who can't get the chemo
drug cisplatin (due to things like hearing loss, kidney failure, or heart failure).
● Avelumab can be used as an additional (maintenance) treatment in people with
advanced bladder cancer that did not get worse during their initial chemotherapy
treatments.
● Pembrolizumab can be used to treat certain bladder cancers that are not growing
into the muscle wall of the bladder, are not getting smaller with intravesical BCG,
and are not being treated with a cystectomy.
These drugs are given as intravenous (IV) infusions, usually every 2 to 6 weeks,
depending on the drug.
Possible side effects
Side effects of these drugs can include:
● Fatigue
● Nausea
● Loss of appetite
● Fever
● Urinary tract infections (UTIs)
● Rash
22
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● Diarrhea
● Constipation
Less often, more serious side effects can occur:
Infusion reactions: Some people might have an infusion reaction while getting one of
these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the
face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell
your doctor or nurse right away if you have any of these symptoms while getting one of
these drugs.
Autoimmune reactions: These drugs work by basically removing one of the

safeguards on the body’s immune system. Sometimes the immune system starts
attacking other parts of the body, which can cause serious or even life-threatening
problems in the lungs, intestines, liver, hormone-making glands, or other organs.
It’s very important to report any new side effects to your health care team right away. If
serious side effects do occur, treatment may need to be stopped and you may get high
doses of steroids to suppress your immune system.
Monoclonal antibodies
Antibodies are proteins made by your immune system to help fight infections. Man-
made versions, called monoclonal antibodies, can be designed to attack a specific
target, such as a protein on the surface of bladder cancer cells. This means these
treatments attack cancers cells but ignore normal cells that don't have the target. This
reduces damage to normal, healthy cells.
Enfortumab vedotin (Padcev)
Enfortumab vedotin is an antibody-drug conjugate (ADC), which is a monoclonal

antibody linked to a chemo drug.
Bladder cancer cells usually have the Nectin-4 protein on their surface. Enfortumab
vedotin is an anti-Nectin-4 antibody attached to a chemo drug (MMAE). The antibody
part acts like a homing signal, bringing the chemo drug to the bladder cancer cells with
Nectin-4 on them. The chemo enters the cancer cells and kills them.
This drug may be used to treat people with advanced bladder cancer who have already
been treated with platinum chemotherapy (such as cisplatin) and immunotherapy
23
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(specifically, a PD-1 or PD-L1 inhibitor).
Enfortumab vedotin is infused into a vein (IV), once a week for 3 weeks with one week
off.
Common side effects include fatigue, peripheral neuropathy (a type of nerve damage),
nausea, taste changes, decreased appetite, diarrhea, rash, hair loss, dry eye, dry skin,
itching, and high blood sugar levels.
More information about immunotherapy
To learn more about how drugs that work on the immune system are used to treat
cancer, see Cancer Immunotherapy1.
Hyperlinks
types/immunotherapy.html
References
Ingersoll MA, Li X, Inman BA, et al. Immunology, Immunotherapy, and Translating Basic
Science into the Clinic for Bladder Cancer. Bladder Cancer. 2018;4(4):429-440.


Petrylak DP, Balar AV, O'Donnell PH, McGregor BA, Heath EI, Yu EY, et al. EV-201:
Results of enfortumab vedotin monotherapy for locally advanced or metastatic urothelial
cancer previously treated with platinum and immune checkpoint inhibitors. J Clin Oncol.
2019; 37:18_suppl, 4505-4505.
24
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Tripathi A, Plimack ER. Immunotherapy for Urothelial Carcinoma: Current Evidence and
Future Directions. Curr Urol Rep. 2018;19(12):109.
Werntz RP, Adamic B, Steinberg GD. Emerging therapies in the management of high-
risk non-muscle invasive bladder cancer (HRNMIBC). World J Urol. 2018 Dec 4.

Last Medical Review: January 30, 2019 Last Revised: July 1, 2020
Targeted Therapy Drugs for Bladder

Cancer
As researchers have learned more about the changes inside cells that cause cancer,
they have developed newer drugs that target some of these changes. These targeted
drugs work differently from other types of treatment, such as chemotherapy (chemo).
They may work in some cases when other treatments don't. Targeted drugs also often
have different types of side effects.
FGFR inhibitor
Fibroblast growth factor receptors (FGFRs) are a group of proteins on bladder cancer
cells that can help them grow. In some bladder cancers, the cells have changes in
FGFR genes (which control how much of the FGFR proteins are made). Drugs that
target cells with FGFR gene changes (called FGFR inhibitors) can help treat some
people with bladder cancer.
Erdafitinib (Balversa)
This FGFR inhibitor can be used to treat locally advanced or metastatic bladder cancer
that has certain changes in the FGFR2 or FGFR3 gene, and that is still growing despite
treatment with chemo. It is taken by mouth as tablets, once a day.
Common side effects include mouth sores, feeling tired, changes in kidney or liver
25
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function, diarrhea, dry mouth, changes in fingernails or toenails, changes in mineral

levels in the blood (such as phosphate and sodium), loss of appetite, changes in how
things taste, low red blood cell counts (anemia), dry skin, dry eyes, and hair loss. Other
side effects can include hand-foot syndrome (redness, swelling, peeling or tenderness
on the hands or feet), constipation, belly pain, nausea, and muscle pain.
This drug can also cause eye problems, which can sometimes be serious, so people
taking this drug need to have regular eye exams and should tell their health care
provider right away if they have blurred vision, loss of vision or other visual changes.
More information about targeted therapy
To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer
Therapy1.
To learn about some of the side effects listed here and how to manage them,
see Managing Cancer-related Side Effects2.
Hyperlinks
1. www.cancer.org/treatment/treatments-and-side-effects/treatment-types/targeted-
therapy.html
References
US Food and Drug Administration. FDA approves first targeted therapy for metastatic
bladder cancer [Press Release]. Accessed at
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm635906.htm on
April 15, 2019.
Last Medical Review: April 15, 2019 Last Revised: April 15, 2019
Treatment of Bladder Cancer, by Stage
26
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Most of the time, treatment of bladder cancer is based on the tumor’s clinical stage1
when it's first diagnosed. This includes how deep it's thought to have grown into the
bladder wall and whether it has spread beyond the bladder. Other factors, such as the
size of the tumor, how fast the cancer cells are growing (grade), and a person’s overall
health and preferences, also affect treatment options.
Treating stage 0 bladder cancer
Stage 0 bladder cancer includes non-invasive papillary carcinoma (Ta) and flat non-
invasive carcinoma (Tis or carcinoma in situ). In either case, the cancer is only in the
inner lining layer of the bladder. It has not invaded (spread deeper into) the bladder wall.
This early stage of bladder cancer is most often treated with transurethral resection
(TURBT) with fulguration followed by intravesical therapy within 24 hours.
Stage 0a
Sometimes no further treatment is needed. Cystoscopy2 is then done every 3 to 6

months to watch for signs that the cancer has come back.
For low-grade (slow-growing) non-invasive papillary (Ta) tumors, weekly intravesical

chemotherapy may be started a few weeks after surgery. If the cancer comes back, the
treatments can be repeated. Sometimes intravesical chemo is repeated over the next
year to try to keep the cancer from coming back.
High-grade (fast-growing) non-invasive papillary (Ta) tumors are more likely to come
back after treatment, so intravesical BCG is often used after surgery. Before it's given,
TURBT is commonly repeated to be sure the cancer has not affected the muscle layer.
BCG is usually started a few weeks after surgery and is given every week for several
weeks. Intravesical BCG seems to be better than intravesical chemotherapy for high-
grade cancers. It can help both keep these cancers from coming back and keep them
from getting worse. But it also tends to have more side effects3. It, too, may be done for
the next year or so.
Stage 0 bladder cancers rarely need to be treated with more extensive surgery. Partial
or complete cystectomy (removal of the bladder) is considered only when there are
many superficial cancers or when cancer continues to grow (or seems to be spreading)
despite treatment.
Stage 0is
27
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For flat non-invasive (Tis) tumors, intravesical BCG is the treatment of choice after
TURBT. Patients with these tumors often get 6 weekly treatments of BCG, starting a
few weeks after TURBT. Some doctors recommend repeating BCG treatment every 3 to
6 months.
Follow-up and outlook after treatment
After treatment for any stage 0 cancer, close follow-up is needed, with cystoscopy about
every 3 months for a least a couple of years to look for signs of the cancer coming back
or new bladder tumors.
The outlook for people with stage 0a (non-invasive papillary) bladder cancer is very
good. These cancers can be cured with treatment. During long-term follow-up care,
more superficial cancers are often found in the bladder or in other parts of the urinary
system. Although these new cancers do need to be treated, they rarely are deeply
invasive or life threatening.
The long-term outlook for stage 0is (flat non-invasive) bladder cancer is not as good as
for stage 0a cancers. These cancers have a higher risk of coming back, and may return
as a more serious cancer that's growing into deeper layers of the bladder or has spread
to other tissues.
Treating stage I bladder cancer
Stage I bladder cancers have grown into the connective tissue layer of the bladder wall
(T1), but have not reached the muscle layer.
Transurethral resection (TURBT) with fulguration is usually the first treatment for these
cancers. But it's done to help determine the extent of the cancer rather than to try to
cure it. If no other treatment is given, many people will later get a new bladder cancer,
which often will be more advanced. This is more likely to happen if the first cancer is
high-grade (fast-growing).
Even if the cancer is found to be low grade (slow-growing), a second TURBT is often
recommended several weeks later. If the doctor then feels that all of the cancer has
been removed, intravesical BCG (preferred) or intravesical chemo is usually given.
(Less often, close follow-up alone might be an option.) If all of the cancer wasn't
removed, options are intravesical BCG or cystectomy (removal of part or all of the
bladder).
If the cancer is high grade, if many tumors are present, or if the tumor is very large
28
____________________________________________________________________________________
when it's first found, radical cystectomy may be recommended.
For people who aren’t healthy enough for a cystectomy, radiation therapy (often along
with chemo) might be an option, but the chances for cure are not as good.
Treating stage II bladder cancer
These cancers have invaded the muscle layer of the bladder wall (T2a and T2b), but no
farther. Transurethral resection (TURBT) is typically the first treatment for these
cancers, but it's done to help determine the extent (stage) of the cancer rather than to
try to cure it.
When the cancer has invaded the muscle, radical cystectomy (removal of the bladder)
is the standard treatment. Lymph nodes near the bladder are often removed as well. If
cancer is in only one part of the bladder, a partial cystectomy may be done instead. But
this is possible in only a small number of patients.
Radical cystectomy may be the only treatment for people who are not well enough to
get chemo. But most doctors prefer to give chemo before surgery because it's been
shown to help patients live longer than surgery alone. When chemo is given first,
surgery is delayed. This is not a problem if the chemo shrinks the bladder cancer, but it
might be harmful if the tumor continues to grow during chemo.
If cancer is found in nearby lymph nodes, radiation may be needed after surgery.
Another option is chemo, but only if it wasn't given before surgery.
Certain people may be able to have a second (and more extensive) transurethral
resection (TURBT), followed by radiation and chemotherapy. While this lets patients
keep their bladder, it’s not clear if the outcomes are as good as they are after
cystectomy, so not all doctors agree with this approach. If this treatment is used,
frequent and careful follow-up exams are needed. Some experts recommend a repeat
cystoscopy and biopsy be done during the chemo and radiation treatment. If cancer is
still found in the biopsy sample, a cystectomy will likely be needed.
For patients who can’t have surgery because of other serious health problems, TURBT,
radiation, chemotherapy, or some combination of these may be options.
Treating stage III bladder cancer
These cancers have reached the outside of the bladder (T3) and might have grown into
nearby tissues or organs (T4) and/or lymph nodes (N1, N2, or N3). They have not
29
____________________________________________________________________________________
spread to distant parts of the body.
Transurethral resection (TURBT) is often done first to find out how far the cancer has
grown into the bladder wall. Chemotherapy followed by radical cystectomy (removal of
the bladder and nearby lymph nodes) is then the standard treatment. Partial cystectomy
is rarely an option for stage III cancers.
Chemotherapy (chemo) before surgery (with or without radiation) can shrink the tumor,
which may make surgery easier. Chemo can also kill any cancer cells that could already
have spread to other areas of the body and help people live longer. It can be especially
useful for T4 tumors, which have spread outside the bladder. When chemo is given first,
surgery to remove the bladder is delayed. The delay is not a problem if the chemo
shrinks the cancer, but it can be harmful if it continues to grow during chemo.
Sometimes the chemo shrinks the tumor enough that intravesical therapy or chemo with
radiation is possible instead of surgery.
Some patients get chemo after surgery to kill any cancer cells left after surgery that are
too small to see. Chemo given after cystectomy may help patients stay cancer-free
longer, but so far it’s not clear if it helps them live longer. If cancer is found in nearby
lymph nodes, radiation may be needed after surgery. Another option is chemo, but only
if it wasn't given before surgery.
An option for some patients with single, small tumors (some T3) might be treatment with
a second (and more extensive) transurethral resection (TURBT) followed by a
combination of chemo and radiation. If cancer is still found when cystoscopy is
repeated, cystectomy might be needed.
For patients who can’t have surgery because of other serious health problems,
treatment options might include TURBT, intravesical therapy, radiation, chemotherapy,
immunotherapy, or some combination of these.
Treating stage IV bladder cancer
These cancers have reached the pelvic or abdominal wall (T4b), may have spread to
nearby lymph nodes (any N), and/or have spread to distant parts of the body (M1).
Stage IV cancers are very hard to get rid of completely.
Chemotherapy (with or without radiation) is usually the first treatment if the cancer has
not spread to distant parts of the body (M0). The tumor is then rechecked. If it appears
to be gone, chemo with or without radiation or cystectomy are options. If there are still
signs of cancer in the bladder, chemo with or without radiation, changing to another kind
30
____________________________________________________________________________________
of chemo, trying an immunotherapy drug, or cystectomy may be recommended.
Chemo (with or without radiation) is typically the first treatment when bladder cancer
has spread to distant parts of the body (M1). After this treatment the cancer is
rechecked. If it looks like it's gone, a boost of radiation to the bladder may be given or
cystectomy might be done. If there are still signs of cancer, options might include
chemo, radiation, both at the same time, or immunotherapy.
In most cases surgery (even radical cystectomy) can’t remove all of the cancer, so
treatment is usually aimed at slowing the cancer’s growth and spread to help people live
longer and feel better. If surgery is a treatment option, it's important to understand the
goal of the operation – whether it's to try to cure the cancer, to help a person live longer,
or to help prevent or relieve symptoms from the cancer.
People who can’t tolerate chemo because of other health problems might be treated
with radiation therapy or with an immunotherapy drug. Urinary diversion without
cystectomy is sometimes done to prevent or relieve a blockage of urine that could
cause severe kidney damage.
Because treatment is unlikely to cure these cancers, many experts recommend taking
part in a clinical trial4.
Treating bladder cancer that progresses or recurs
If cancer continues to grow during treatment (progresses) or comes back after treatment
(recurs), treatment options will depend on where and how much the cancer has spread,
what treatments have already been used, and the patient's overall health and desire for
more treatment. It’s important to understand the goal of any further treatment – if it’s to
try to cure the cancer, to slow its growth, or to help relieve symptoms – as well as the
likely benefits and risks.
For instance, non-invasive bladder cancer often comes back in the bladder. The new
cancer may be found either in the same place as the original cancer or in other parts of
the bladder. These tumors are often treated the same way as the first tumor. But if the
cancer keeps coming back, a cystectomy (removal of the bladder) may be needed. For
some non-invasive tumors that keep growing even with BCG treatment, and where a
cystectomy is not an option, immunotherapy with pembrolizumab might be
recommended.
Cancers that recur in distant parts of the body can be harder to remove with surgery
and other treatments, such as chemotherapy, immunotherapy, targeted therapy, or
31
____________________________________________________________________________________
radiation therapy, might be needed. For more on dealing with a recurrence, see
Understanding Recurrence5.
At some point, it may become clear that standard treatments are no longer controlling
the cancer. If the patient wants to continue getting treatment, taking part in a clinical
trial6 of newer bladder cancer treatments might be recommended. While these are not
always the best option for every person, they can benefit current, as well as future
patients.
The treatment information in this document is not official policy of the American Cancer
Society and is not intended as medical advice to replace the expertise and judgment of
your cancer care team. It is intended to help you and your family make informed
decisions, together with your doctor. Your doctor may have reasons for suggesting a
treatment plan different from these general treatment options. Don't hesitate to ask him
or her questions about your treatment options.
Hyperlinks
1. www.cancer.org/cancer/bladder-cancer/detection-diagnosis-staging/staging.html
2. www.cancer.org/treatment/understanding-your-
diagnosis/tests/endoscopy/cystoscopy.html
4. www.cancer.org/treatment/treatments-and-side-effects/clinical-trials.html
5. www.cancer.org/treatment/survivorship-during-and-after-treatment/understanding-
recurrence.html
6. www.cancer.org/treatment/treatments-and-side-effects/clinical-trials.html
References
American Society of Clinical Oncology. Bladder Cancer: Treatments by Stage. 10/2017.

Accessed at www.cancer.net/cancer-types/bladder-cancer/treatments-stage on January
25, 2019.
DeGeorge KC, Holt HR, Hodges SC. Bladder Cancer: Diagnosis and Treatment. Am
Fam Physician. 2017;96(8):507-514.

32
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National Cancer Institute. Bladder Cancer Treatment (PDQ®)–Patient Version. October

19, 2018. Accessed at www.cancer.gov/types/bladder/patient/bladder-treatment-pdq on
January 25, 2019.


Last Medical Review: January 30, 2019 Last Revised: July 1, 2020
Written by
The American Cancer Society medical and editorial content team

(www.cancer.org/cancer/acs-medical-content-and-news-staff.html)
Our team is made up of doctors and oncology certified nurses with deep knowledge of
cancer care as well as journalists, editors, and translators with extensive experience in
medical writing.
American Cancer Society medical information is copyrighted material. For reprint

requests, please see our Content Usage Policy (www.cancer.org/about-
us/policies/content-usage.html).
cancer.org | 1.800.227.2345
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Treating Bladder Cancer

How is bladder cancer treated?

● Bladder Cancer Surgery

Common treatment approaches

● Treatment of Bladder Cancer, by Stage

Who treats bladder cancer?

● Health Professionals Associated With Cancer Care

Making treatment decisions

● Your age and expected life span

● Questions To Ask About Bladder Cancer

Help getting through cancer treatment

Choosing to stop treatment or choosing no treatment at all

● If Cancer Treatments Stop Working

Bladder Cancer Surgery

Transurethral resection of bladder tumor (TURBT)

A transurethral resection of bladder tumor (TURBT) or a transurethral resection (TUR) is

How TURBT is done

Possible side effects

In patients with a long history of recurrent, non-invasive low-grade tumors (slow-growing

Reconstructive surgery after radical cystectomy

Risks and side effects of cystectomy

Effects of cystectomy on urination

To learn a lot more about urostomies, see Urostomy Guide2.

Sexual effects of radical cystectomy in men

Sexual effects of radical cystectomy in women

Sexual effects of urostomy

More information about Surgery

American Society of Clinical Oncology. Bladder Cancer: Treatment Options. 10/2017.

Encyclopedia of Surgery. Cystectomy. Accessed at www.surgeryencyclopedia.com/Ce-

National Cancer Institute. Bladder Cancer Treatment (PDQ®)–Health Professional

National Cancer Institute. Bladder Cancer Treatment (PDQ®)–Patient Version. October

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology

See all references for Bladder Cancer (www.cancer.org/cancer/bladder-

Intravesical Therapy for Bladder Cancer

When is intravesical therapy used?

Intravesical therapy is commonly used after transurethral resection of bladder tumor

To treat non-invasive bladder cancer

Intravesical chemotherapy or immunotherapy may used for intermediate non-invasive

High-risk non-invasive bladder cancers might be fast-growing (high-grade), big, or there

Intravesical immunotherapy maintenance treatment schedules vary. For instance,

To treat higher-stage, invasive bladder cancers

Sometimes induction and maintenance intravesical immunotherapy is used after

Types of intravesical therapy

There are 2 types of intravesical therapy:

Bacillus Calmette-Guerin or BCG is the most common intravesical immunotherapy for

American Urological Association. Intravesical Administration of Therapeutic Medication.

de Jong JJ, Hendricksen K, Rosier M, Mostafid H, Boormans JL. Hyperthermic

Green DB, Kawashima A, Menias CO, et al. Complications of Intravesical BCG

Manikandan R, Rodriguez O, Parada R, Palou Redorta J. Nonmuscle-invasive bladder

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology

Porten SP, Leapman MS, Greene KL. Intravesical chemotherapy in non-muscle-

See all references for Bladder Cancer (www.cancer.org/cancer/bladder-

Chemotherapy for Bladder Cancer

When is chemotherapy used?

Systemic chemo can be used :

Which chemo drugs are used to treat bladder cancer?

● Gemcitabine and cisplatin

Side effects of chemotherapy