Here at MD Anderson, you receive personalized bladder cancer care from some of the nation’s leading specialists. They focus extraordinary expertise on your treatment and recovery.
Your bladder cancer care is customized to include the most advanced therapies. Many of these are available at only a few locations in the United States, including:
Advanced surgical and reconstructive procedures
- Laparoscopic robotic surgery
- Conformal 3D and IMRT radiotherapy
- Immunotherapy, including Bacillus Calmette-Guérin (BCG)
- Latest chemotherapy 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.
Surgery is part of almost every bladder cancer patient’s treatment. Other types of treatment often are given before or after 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, and in women the uterus, ovaries, fallopian tubes and often a small part of the vagina are removed.
Minimally invasive surgery techniques such as laparoscopy and robotic procedures are available at MD Anderson for some bladder cancer patients.
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 types of urinary diversion:
Ileal neobladder: Part of the ileum (small intestine) is used to make a new bladder, allowing for "normal" urination. This procedure is more successful for men. It provides good daytime urinary control, with about a 20% chance of nighttime incontinence. Some women may have trouble completely emptying the neobladder and may sometimes need to use a catheter.
Ileal conduit: A piece of the small intestine is used to create a “pipe” that connects the ureters to the surface of the skin in the navel. Urine is continuously drained into a urostomy bag 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. The patient uses a catheter to drain the pouch every three to four hours. This procedure is done less frequently.
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.
The main chemotherapy for metastatic bladder cancer is a combination of four drugs known as MVAC: methotrexate, vinblastine, adriamycin and cisplatin. MVAC has provided good response rates since the 1980s. In recent years, the MVAC treatment regimen has been decreased from four weeks to two weeks, with less impact on the body and an improved response rate of 50% and higher.
Another chemotherapy regimen for bladder cancer is a combination of gemcitabine and cisplatinum. It has less impact on the body than MVAC, with similar response rates. Both chemotherapies have an average survival rate of 14 months.
A number of new chemotherapy treatments are being studied in clinical trials for their effectiveness for advanced bladder cancer, including two developed at MD Anderson:
- A three-week regimen of ifosphamide, adriamycin and gemcitabine
- A two-week regimen of cisplatinum, gemcitabine and ifosphamide
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 (neoadjuvant therapy).
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.
Although surgery is the frontline treatment for bladder cancer, radiation treatment has a role in certain patients. Simultaneous radiation and chemotherapy with cisplatin may be used instead of surgery in an effort to save the bladder. However, only about 40% of patients who have this treatment will be able to keep their bladders and not have the cancer come back.
The best candidates for radiation therapy:
- Have tumors that are localized in the bladder and have not spread
- Have only one tumor site
- Can tolerate chemotherapy and 35 radiation treatments
- Are willing to undergo rigorous follow-up after treatment
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target bladder cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson provides the most advanced radiation treatments for bladder cancer, including:
- 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
- Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor
Bacillus Calmette-Guérin (BCG), a bacterial organism used to treat tuberculosis, is the standard immunotherapy for superficial bladder cancer. First, the bladder wall is scraped to remove superficial tumor cells. Then, the bladder is filled with a solution containing BCG. The BCG, delivered through a catheter, 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, and the success rate is 70% to 80%.
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.