Bladder Cancer Treatment

At MD Anderson, you receive personalized bladder cancer care from some of the nation’s leading specialists. A team including urologic surgeons, medical oncologists and radiation oncologists work together to plan your treatment and recovery.

Your bladder cancer care is customized to incorporate the most advanced therapies, including:

• Advanced surgical and reconstructive procedures, including robotic surgery and robotic reconstructive surgery.
• Advanced cancer drugs, including antibody drug conjugates and targeted therapies.
• Radiation techniques designed to deliver high doses of radiation to the tumor while sparing healthy tissue.

Our skilled surgeons, who utilize the latest bladder cancer and reconstruction techniques, are among the most experienced in the nation. This can make an essential difference in the success of your treatment and recovery.

And, as one of the nation’s largest cancer research centers, we offer a variety of clinical trials for new therapies for bladder cancer.

If you are diagnosed with bladder cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

Your treatment for bladder cancer at MD Anderson will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Bladder cancer treatment plans

For patients whose bladder cancer has not spread to distant parts of the body, treatment will generally include surgery. If this cancer is in its early stages and has not moved into to the muscle wall, patients may receive intravesical therapy (washing the inside of the bladder with immunotherapy or chemotherapy drugs).

For patients whose disease has spread into the bladder's muscle wall, there are two main treatment options. One is surgery to remove the bladder. These patients may receive chemotherapy before surgery to shrink the tumor.

The other is a combination of three treatments designed to let patients keep their bladder: Transurethral resection, which involves scraping cancer cells from the inner surface of the bladder, followed by chemotherapy and radiation therapy. This treatment is an option for selected patients, often those with smaller tumors. It is also used for patients who are not good candidates for surgery.

Patients whose cancer has spread beyond the bladder to distant sites like the lungs, liver or bones, usually get chemotherapy, immunotherapy, or targeted therapy. These patients may also be eligible for clinical trials.

Bladder cancer treatments

Bladder cancer surgery

Surgery is part of almost every bladder cancer patient’s treatment. It is often offered with other types of treatment given before or after the procedure.

In many cases, MD Anderson surgeons operate on bladder cancer patients with minimally invasive techniques, such as robotic cystectomy and robotic reconstruction procedures. These may offer shorter hospital stays, less blood loss and faster recovery times.

There are two primary types of bladder cancer surgery:

Transurethral resection (TUR) involves scraping the tumor from the bladder wall. It can be used to retrieve suspected cancer cells for a diagnosis and to help treat bladder cancer. The procedure is done with a resectoscope, a thin tool with a wire loop on the end that is placed through the urethra and into the bladder. TUR can be used on its own for superficial bladder cancer. It can also be used in combination with chemotherapy and radiation therapy for cancers that have moved into the bladder’s muscle wall. 

Cystectomy, or removal of the bladder, is often used in more advanced bladder cancer. Usually the entire bladder is removed, but a few patients are candidates for a partial cystectomy. Lymph nodes near the bladder will also be removed. In men, the prostate also is usually removed. In women, the uterus, ovaries, fallopian tubes and often a small part of the vagina may need to be removed, though many times this is not required.

Bladder reconstruction surgery

When the bladder is removed to treat bladder cancer, surgical procedures known as urinary diversions are performed to give the body a way to store and remove urine. Urinary diversions are done at the same time as a cystectomy. There are three common types of urinary diversion:

Ileal conduit: This is the most common urinary diversion. A piece of the small intestine is used to create a “pipe” that connects the ureters to the surface of the skin. This opening, called a stoma, is usually located a few inches to the right of the bellybutton. Urine is continuously drained into a urostomy bag connected to the stoma and worn on the outside of the body. It is a simple and efficient procedure, but some patients may have issues with wearing an external bag.

Ileal neobladder: Part of the ileum (small intestine) is used to make a new bladder, allowing for urination through the urethra. This procedure is more common for men than women. For most patients, it provides good daytime urinary control, with about a 20% chance of nighttime incontinence. Patients who get an ileal neobladder may need occasional catheterization. This need is slightly more common in women than men.

Continent reservoir: Intestinal tissue is used to create an internal pouch that is connected to the navel or a nearby spot. The patient uses a catheter to drain the pouch every three to four hours. This type of reconstruction can avoid a stoma when a neobladder is not feasible or recommended.

Chemotherapy

Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.

Chemotherapy can be used with surgery when bladder cancer has a high risk of metastasis. Bladder tumors that have invaded the muscle wall and have the potential to spread can benefit from chemotherapy before surgery.

Doctors are studying new chemotherapy treatments for treating advanced bladder cancer.

Learn more about chemotherapy.

Antibody Drug Conjugates

Antibody drug conjugates link cancer fighting drugs like chemotherapy with antibodies designed in a lab to recognize cancer cells. This combination delivers powerful doses of medication while limiting negative side effects.

Antibody drug conjugates are currently approved only for patients with metastatic bladder cancer. Research is underway to expand their use to other patients.

Immune checkpoint inhibitors

Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is completely eliminated. 

For bladder cancer, immune checkpoint inhibitors are currently used only for stage IV cancer. Clinical trials are underway to study the use of these drugs in other settings.

Learn more about immune checkpoint inhibitors.

Targeted therapy

Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. 

Targeted therapy is currently only approved to treat stage IV cancers with specific genetic mutations.

Learn more about targeted therapy.

Radiation therapy

Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue. 

The types of radiation used to treat bladder cancer include: 

• Intensity modulated radiation therapy (IMRT), which focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose. 
• Volumetric modulated arc therapy, a form of IMRT that utilizes a rotating treatment machine to deliver radiation at multiple angles. 

For bladder cancer patients, radiation therapy is used in combination with chemotherapy and transurethral resection surgery.    

Learn more about radiation therapy.

Intravesical therapy

Superficial bladder cancer has a high rate of recurrence. Intravesical therapy can help decrease the risk of tumor recurrence and progression (tumor growing deeper into bladder wall). First, the bladder wall is scraped to remove any superficial tumor cells. After the patient has recovered from surgery, doctors use a catheter to fill the bladder with a medication to destroy any remaining cancer cells and prevent recurrence. The medication may be Bacillus Calmette-Guérin (BCG), an immunotherapy that stimulates the patient’s immune system to destroy cancer cells, or a chemotherapy drug.

Gene therapy

Gene therapy modifies a patient's DNA to fight cancer. These therapies can insert a healthy copy of a gene into a cell, remove or replace parts of an abnormal gene, inhibit the growth of cancer cells and prevent the production of disease cells.

For bladder cancer, gene therapy is used to treat patients whose disease has not spread into the muscle walls but does not respond to intravesical therapy.

Bladder cancer clinical trials 

Clinical trials are a key component of MD Anderson's mission to end cancer. MD Anderson uses clinical trials to find better ways to prevent, diagnose and treat cancer. 

Clinical trials for bladder cancer include expanding the use of immunotherapy, targeted therapy and antibody drug conjugates, as well as combinations of these and other treatments.

Your doctor may offer you a clinical trial as a treatment option.

Learn more about clinical trials.

In rare cases, bladder cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.