When bladder cancer has invaded the muscle, the most common treatment is surgery. Other treatments, such as chemotherapy, may be combined with surgery. Some bladder cancers may be treated with only a combination of chemotherapy and radiotherapy.
Surgery is the preferred treatment for muscle-invasive disease, or for cancer that has invaded the lamina propria and has not responded to BCG. The main operation is the removal of the bladder (cystectomy). This can be done in different ways.
A radical cystectomy is the most common operation for muscle- invasive bladder cancer. The whole bladder and nearby lymph nodes are removed. In men, the prostate, urethra and seminal vesicles may also be removed. In women, the urethra, uterus, ovaries, fallopian tubes and a portion of the vagina are often removed.
It may be possible to remove the bladder using keyhole surgery, also known as minimally invasive or laparoscopic surgery. In some cases, the surgeon will be assisted by the robotic da Vinci system.
In keyhole surgery, the surgeon makes a few small cuts in the abdomen to insert the instruments, rather than one large cut (open technique). Recovery is usually faster with keyhole surgery, but open surgery is still recommended in some situations.
This type of operation is not suitable for most types of bladder cancer, so it is less common. A partial cystectomy removes only the bladder tumour and a border of healthy tissue around it.
After a radical cystectomy, you will probably stay in hospital for 1–2 weeks. You will have tubes in your body to give you fluids and to drain the operation area. You may have pain after the surgery and need pain relief for a few days.
After a partial cystectomy, your bladder will be smaller and hold less urine, so you may need to pass urine more often.
If you have a radical cystectomy, removing the bladder and surrounding organs will change the way your body functions. In men, the nerves needed to get an erection are likely to be affected. Women who have their reproductive organs removed will go through menopause if they have not already. These changes may affect how you feel about your appearance, sex life and fertility.
With the bladder removed, you will need to store urine in another way. This is called a urinary diversion.
There are various options for surgically reconstructing the bladder after a cystectomy – for more information, see living with a bladder reconstruction.
Urothelial carcinoma is the most common form of bladder cancer, but occasionally it can occur in a ureter or kidney.
Much of this section will be relevant if you have been diagnosed with urothelial cancer of the kidney or ureter. Symptoms include blood in the urine and back pain. Many of the same tests will be used for diagnosis, but instead of a cystoscopy, you will have a ureteroscopy, which uses a thin instrument with a light to examine the ureter and kidney.
The most common treatment is surgery to remove the kidney, ureter and part of the bladder (nephroureterectomy). Sometimes, only part of the ureter or kidney needs to be removed (segmental resection). Chemotherapy or immunotherapy may be used after surgery.
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. It aims to kill cancer cells while doing the least possible damage to healthy cells.
For muscle-invasive bladder cancer, drugs are given by injection into a vein (intravenously). As the drugs circulate in the blood, they travel throughout the body. This type of chemotherapy is called systemic chemotherapy. It is different to the intravesical chemotherapy used for non-muscle-invasive bladder cancer, which is delivered directly to the bladder.
You may have systemic chemotherapy:
Systemic chemotherapy is given as a course of drugs over a few days. The drugs are given every few weeks for several months.
Systemic chemotherapy drugs circulate in the body and can affect normal, healthy cells as well as cancer cells. This can lead to side effects, which may include:
Generally, side effects are temporary. However, sometimes the effects are long-term or permanent. Some side effects can be eased with prescription drugs; talk to your doctor about this.
During chemotherapy, you may be more prone to infections. If you develop a temperature over 38°C, contact your doctor or go to the emergency department at your nearest hospital.
Radiotherapy uses high energy x-rays to kill cancer cells or injure them so they cannot multiply. It may be used instead of surgery to treat muscle-invasive bladder cancer without removing the bladder.
On its own, radiotherapy may not cure the cancer. Sometimes, chemotherapy is given with radiotherapy to make the cells more sensitive to the radiation. This may be called chemoradiation.
During a radiotherapy session, you will lie on an examination table and a machine will direct the radiotherapy towards your body. The treatment is painless and can’t be seen or felt. Radiotherapy is usually given from Monday to Friday for several weeks. You will meet with the radiation oncology team to plan your treatment.
Radiotherapy for bladder cancer can cause temporary side effects, including:
Less commonly, radiotherapy may permanently affect the bowel or bladder. More frequent and looser bowel motions may occur. You may also have bladder irritation and blood in the urine.
If the bladder cancer spreads or returns after treatment, your doctor will discuss palliative treatment for symptoms caused by the cancer, such as pain.
Palliative treatment aims to manage symptoms without trying to cure the disease. It can be used at any stage of advanced cancer to improve quality of life. It is not just for people who are about to die and does not mean giving up hope. Rather, it is about living for as long as possible in the most satisfying way you can.
As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. The treatment may include radiotherapy, chemotherapy, targeted therapies or other types of medicine.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs. The team also provides support to families and carers. For more information, see palliative care and living with advanced cancer.