How Is Bladder Cancer Treated?

There are many different types of treatment for bladder cancer. Your care team will help determine what the best treatment is for you. This can depend on the stage and grade of your cancer, as well as other factors.¹

Surgery

Surgery is one of the most common treatments for bladder cancer. Different types of surgery may be used for bladder cancer. These include:^1-3

• Transurethral resection (TUR) – During the surgery, a doctor inserts a thin, lighted tube through the urethra to the bladder. This helps your doctor get images of the bladder tissue. A doctor will also typically use a small tool to remove tissue suspected of being cancerous. If they use electric current to burn away the tumor, it is called fulguration. If they use lasers, it is called laser ablation.
• Partial cystectomy – This is surgery to remove part of the bladder.
• Radical cystectomy with urinary diversion – Radical cystectomy involves the total removal of the bladder. It may also remove lymph nodes or nearby organs that have cancer. After removing the bladder, the surgeon also creates a way for the body to store and pass urine. This is called the urinary diversion. The method used can vary.

Immunotherapy

Immunotherapy treatments are designed to help your own immune system fight cancer. In bladder cancer treatment, this includes systemic immunotherapy and intravesical immunotherapy.^1,3

Systemic immunotherapy is an option for certain types of bladder cancer. Systemic immunotherapy travels throughout the whole body. Types of systemic immunotherapy treatments approved for certain forms of bladder cancer in the United States include:^1,3

• Nivolumab (Opdivo^®)
• Avelumab (Bavencio^®)
• Pembrolizumab (Keytruda^®)
• Durvalumab (Imfinzi®)

Intravesical immunotherapy is immunotherapy that is delivered directly into the bladder. This is most commonly done with Bacillus Calmette-Guerin (BCG). BCG is a bacteria. When it is placed into the bladder, it stimulates the immune system to fight cancer cells.^1,3,4

• Nadofaragene iradenovec (Adstiladrin®)
• Nogapendekin alfa inbakicept (Anktiva®)

Targeted therapy

Targeted therapy is a type of treatment that targets specific cancer genes, enzymes, or proteins. By targeting these things, the treatment can slow or block the growth and spread of the cells. The specific target of the treatment and the way it works depend on the drug.^1,3

Targeted therapies that may be used to treat certain forms of bladder cancer include:^1,3

• Erdafitinib (Balversa^®)
• Enfortumab vedotin (Padcev^®)

Chemotherapy

Chemotherapy drugs are powerful drugs that stop the growth of cancer cells. Depending on the drug, they either kill the cells or stop them from dividing. Like immunotherapy, chemotherapy can also be either systemic or intravesical in bladder cancer treatment.^1,3

Systemic chemotherapy is often injected into a vein or muscle and works throughout the entire body. Examples of systemic chemotherapy drugs for bladder cancer include:^1,3

• Cisplatin
• Gemcitabine
• Mitomycin
• Paclitaxel

Intravesical chemotherapy is given directly to the bladder through a catheter. These drugs are sometimes the same as systemic drugs. But they are delivered to the body differently. Examples of intravesical chemotherapy drugs include:^1,3

• Gemcitabine
• Mitomycin
• Valrubicin

Radiation

Radiation therapy uses high-energy X-rays or other types of radiation. The radiation is focused on the body to kill cancer cells inside the body. For people with bladder cancer, radiation therapy may be used with other treatments, like surgery.^1,3

Gene therapy

Gene therapy is a treatment that changes the genetic code of cells. This can make them do new or improved things. It can be used to train the immune system to find and destroy cancer cells. It can also help protect cells from the side effects of cancer treatment.3

A type of gene therapy called nadofaragene firadenovec (Adstiladrin®) is approved for some types of bladder cancer. It is given directly into the bladder. It contains a gene that helps bladder cells make a protein that allows the body to destroy cancer cells.³

Complementary and alternative therapies

Complementary and alternative medicine (CAM) are treatment options that are not part of standard medical care. Examples of CAM include meditation, acupuncture, and massage therapy. Some people find that CAM treatments can help relieve some symptoms of cancer and/or side effects of cancer treatment and improve their quality of life.⁴

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. Your provider can make sure that it will not be harmful to you or interact badly with your cancer treatments.⁴

Before beginning treatment for bladder cancer, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.