Bladder Cancer Treatment

At MD Anderson, you receive personalized bladder cancer care from some of the nation’s leading specialists. A team including urologists, surgeons 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
• Robotic surgery
• Conformal 3D and IMRT radiotherapy
• Robotic reconstruction options

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 of 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. For superficial disease, patients may also receive intravesical therapy to stimulate the immune system to fight the disease.  For some patients, this treatment makes surgery possible. In other cases, it allows patients to get organ-sparing surgery instead of having the entire bladder removed.

In muscle-invasive disease, patients will often get chemotherapy and/or radiation therapy before or after surgery to help shrink the tumor. These treatments are used to kill remaining cancer cells that are not visible to the naked eye. Many patients join clinical trials where they receive medications that are being evaluated for use as bladder cancer treatments, including immunotherapy and targeted therapy options.

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 are able to operate on bladder cancer patients with minimally invasive techniques, 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) may be used for early-stage or superficial bladder cancer. A resectoscope, which is a thin tool with a wire loop on the end, is threaded through the urethra to the bladder, and then the tumor is scraped from the bladder wall. Fluorescence cystoscopy, a special way of looking at the bladder wall, may be used to enhance bladder cancer detection.

Cystectomy, which is removal of the bladder, is often used in more advanced bladder cancer. Usually the entire bladder is removed, but partial cystectomies may be appropriate for a small number of patients. Lymph nodes near the bladder also will be removed. The prostate is removed in men. 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 your 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 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 illeal neobladder may need occasional catheterization. This need is slightly more common in women than men.

Ileal conduit: 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.

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 plays a major role in the treatment of bladder cancer that has spread (metastasized) to the lymph nodes, lungs, liver and other parts of the body. In these patients, chemotherapy is the frontline treatment.

A number of new chemotherapy treatments are being studied in clinical trials for their effectiveness for advanced bladder cancer.

Chemotherapy also is 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.

MD Anderson researchers are continuing to study chemotherapy combinations and dosages to improve response rates, slow tumor regrowth and decrease side effects for bladder cancer patients.

Radiation therapy

Although surgery is the frontline treatment for bladder cancer, radiation treatment has a role in certain patients. Among ideal radiation therapy candidates, about 60% are able to keep their bladders and not have the cancer return.

The best candidates for radiation therapy:

• Have only one tumor site.
• Can tolerate chemotherapy and 35 radiation treatments.
• Are willing to undergo rigorous follow-up after treatment.

MD Anderson provides the most advanced radiation treatments for bladder cancer. These include image-guided techniques like MRI linac and full CT units integrated into radiation therapy rooms, allowing doctors to precisely target tumors.

Intravesecal therapy

This treatment is used to treat superficial bladder cancer. First, the bladder wall is scraped to remove superficial tumor cells. Then, doctors use a catheter to fill the bladder with a solution containing Bacillus Calmette-Guérin (BCG), a bacterial organism. BCG stimulates an immune response within the bladder to destroy any remaining cancer cells. BCG is the most effective agent for keeping the bladder cancer from spreading or coming back. The success rate is approximately 70% in ideal circumstances.

Gene therapy

At MD Anderson, we have the expertise to examine each bladder cancer tumor carefully to determine gene-expression profiles. Ongoing research will help us determine the most effective and least invasive treatment targeted to specific cancers. This personalized medicine approach sets us above and beyond most cancer centers and allows us to attack the specific causes of each cancer for the best outcomes.

Bladder cancer clinical trials

MD Anderson researchers are developing new treatments for patients with bladder cancer. One area of study is immunotherapy. These drugs work by improving the ability of the patient’s immune system to fight cancer. Most immunotherapies that are currently in clinical trial for bladder cancer are checkpoint inhibitors, which keep the immune system from shutting off before the cancer is completely destroyed.

Researchers are also exploring targeted therapies for bladder cancer. These drugs do not directly kill cancer cells. Instead, they stop or slow the spread of cancer by interfering with, or targeting, the molecules cancer cells need to survive and expand.

Visit our clinical trials site to learn more and search for 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.