How Is Bladder Cancer Treated?
There are many different treatments and combinations of treatments available for patients diagnosed with bladder cancer. The type of treatment(s) that a patient may need depends upon the stage and grade of the bladder cancer. Treatment options may include:
- Radiation therapy
- BCG intravesical immunotherapy
- Chemotherapy (intravesical and/or systemic)
- Immunotherapy medications
- Targeted therapy
- Laser ablation therapy
- Tissue-agnostic treatment
- Complementary/alternative methods
Which surgeries are used?
Most patients diagnosed with bladder cancer will have some form of surgery as part of their treatment.1 The following types of surgery are often used to treat bladder cancer:
- Transurethral resection of bladder tumor (TURBT)
- Radical or partial cystectomy
- Reconstructive surgery
- Lymph node dissection
Transurethral resection of bladder tumor (TURBT) is a type of surgery performed using a cystoscope, which is a small thin surgical instrument inserted into the patient’s bladder through the urethra. TURBT is commonly used as part of the initial process of diagnosing and staging a patient’s bladder cancer. In patients with non-muscle-invasive bladder cancer, TURBT is often used to remove tumors and surrounding tissue from the lining of the bladder.
Many patients with muscle-invasive bladder cancer may need to have radical cystectomy surgery, in which the surgeon removes the patient’s entire bladder. The surgeon then typically performs reconstructive surgery to create a new way for the patient’s body to store and pass urine. In partial cystectomy surgery, which is less common, the surgeon removes only a part of the patient’s bladder. Lymph node dissection surgery is commonly performed at the same time as a cystectomy. During this surgery, the surgeon removes lymph nodes in the patient’s pelvis.
What is radiation therapy?
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation that are focused onto a patient’s body to kill cancer cells inside the body.2 In patients with bladder cancer, radiation therapy is generally used in combination with other treatment(s), such as surgery.
What is BCG immunotherapy treatment?
Bacillus Calmette-Guerin (BCG) immunotherapy treatment is a type of intravesical immunotherapy that is delivered directly into the patient’s bladder.3 BCG contains bacteria that help the body’s own immune system to attack cancer cells in the bladder lining. It is often used to treat patients with non-muscle-invasive bladder cancer who have had TURBT surgery to remove tumors from the lining of the bladder. BCG treatment can also be used as maintenance therapy for patients with certain types of bladder cancer that are more likely to recur, to attempt to prevent bladder cancer cells from growing back again after the patient’s initial treatment.
What is maintenance therapy?
After their initial round of treatment, patients with certain types of bladder cancer may be advised to have maintenance therapy with Bacillus Calmette-Guerin (BCG) immunotherapy.3 The aim of maintenance therapy is to attempt to reduce the chance that bladder cancer will recur and start growing again after the initial treatment is completed. BCG immunotherapy is delivered directly into the patient’s bladder. Depending on their healthcare provider’s advice, patients may repeat BCG treatment every few months for one or more years.
What types of chemotherapy are used?
Chemotherapy treatment includes powerful medicines that attack cancer cells that are rapidly dividing in a patient’s body.4,5 Two types of chemotherapy may be used to treat bladder cancer: intravesical chemotherapy and systemic chemotherapy. Intravesical chemotherapy is delivered directly into the patient’s bladder through a catheter. This type of chemotherapy is generally used to treat patients with non-muscle-invasive bladder cancer after they have had TURBT surgery, in order to help prevent the cancer cells from recurring in the bladder lining.
Patients with muscle-invasive, advanced, or metastatic bladder cancer may need to have treatment with systemic chemotherapy, which in bladder cancer is injected into the patient’s muscle or vein. Systemic chemotherapy may be used before surgery (neoadjuvant chemotherapy), after surgery (adjuvant chemotherapy), or in combination with radiation therapy (chemoradiation therapy).
What types of immunotherapy are used?
For patients with certain forms of bladder cancer, including some advanced and metastatic bladder cancers, as well as specific other forms of bladder cancer, immunotherapy medicines are a potential treatment option. The exact use of immunotherapy in bladder cancer depends on the individual medication being utilized for treatment.6 Immunotherapy drugs affect the patient’s immune system in ways that help it to attack cancer cells more effectively. Immunotherapy drugs that are currently approved in the United States for treating patients with certain forms of bladder cancer include:
- Nivolumab (brand name: Opdivo)
- Avelumab (brand name: Bavencio)
- Pembrolizumab (brand name: Keytruda)
- Atezolizumab (brand name: Tecentriq)
What is targeted therapy?
Targeted therapies are a newer treatment option for certain forms of locally advanced or metastatic bladder cancer. Targeted therapies are different from other treatments like chemotherapy because they focus on specific parts of certain cancer cells in an attempt to provide treatment for cancer that does less damage to healthy cells. Targeted therapies currently approved in the US for certain forms of bladder cancer include:
- Erdafitinib (brand name: Balversa)
- Enfortumab vedotin (brand name: Padcev)
- Sacituzumab govitecan (brand name: Trodelvy)
What is laser ablation therapy?
In laser ablation therapy, a surgeon uses a thin, focused beam of powerful infrared light to burn away tiny areas of cells or tissue.7 In patients with early-stage non-muscle-invasive bladder cancer, this therapy can be used to destroy cancer cells located in the bladder lining. In patients with advanced bladder cancer that has grown into or beyond the muscle of the bladder wall, laser ablation therapy can be used to help reduce tumor size and relieve symptoms. Laser ablation therapy is often combined with other types of treatments, such as surgery, chemotherapy, and/or radiation therapy.
What is tissue-agnostic treatment?
Tissue-agnostic therapy is a type of treatment that treats various forms of cancer as long as the cancer has a specific molecular change or biomarker that is targeted by the treatment. This is different from other treatments that depend on the type of tissue or location of the cancer. Tissue-agnostic drugs are studied in clinical trials known as “basket trials,” which are clinical trials that test how well a drug works for treating multiple types of cancer within the same trial.8 Several tissue-agnostic treatments have been approved by the FDA and others are currently being studied.
What is complementary and alternative medicine?
Complementary and alternative medicine (CAM) consists of products and practices that are not usually treatment options in the standard medical system, such as meditation, acupuncture, and massage therapy, for example.9 Some patients find CAM treatments can help relieve some symptoms or side effects of cancer and improve their quality of life. CAM treatments should only be used in addition to your medical cancer treatments, never instead of those treatments. It is important to speak with your healthcare providers before starting treatment with any sort of CAM, to make sure that it will not be harmful to you or interact badly with your cancer treatments.