Treatment of bladder cancer depends on:
How aggressive the cancer is
If it has spread beyond the lining of the bladder
How much it has spread
Tumor grade. The tumor grade is an estimate of how likely the cancer is to grow and spread rapidly.
High grade bladder cancer is likely to grow and spread quickly and become life threatening. High-grade cancers often need to be treated with chemotherapy, radiation or surgery.
Low-grade cancers appear non-aggressive and have a low chance of becoming high grade. They are rarely life threatening. Low-grade tumors tend to come back and need to be removed repeatedly. Still, aggressive treatments, such as radiation or bladder removal, are not usually needed.
The stage is determined by whether:
The tumor involves only the bladder lining
The tumor has invaded the bladder muscle, tissues around the bladder or nearby organs
The cancer has spread to nearby lymph nodes
The cancer has spread to distant sites in other areas of the body
Treatment options vary depending on the stage.
Superficial tumors are cancers that involve only the bladder lining. These tumors are usually low-grade.
Superficial tumors are usually treated with a procedure called a transurethral resection. In this procedure, the doctor either removes the tumor or burns it away.
After transurethral resection, the doctor may place medications inside the bladder. This reduces the chance that the cancer will return. It may also prevent the cancer from progressing to a more advanced and dangerous stage.
High-grade superficial tumors that return more than once or twice after treatment are more serious. Many experts recommend that people with these types of tumors have surgery to remove the bladder. This is a major operation.
Carcinoma in situ
Carcinoma in situ is bladder cancer within only the most superficial lining of the bladder. Carcinoma in situ can be difficult to remove completely. Transurethral resection and medical therapy sometimes eliminate carcinoma in situ. If this fails, doctors usually recommend removing the bladder.
Radiation and chemotherapy are not effective against carcinoma in situ.
Tumors invading the bladder muscle
In this case, bladder cancer has grown into the muscle of the bladder wall. But it has not spread to the lymph nodes or distant organs.
The standard treatment is a surgery called radical cystectomy. Radical cystectomy removes the bladder, nearby lymph nodes and other nearby organs.
After removing the bladder, the surgeon must create a different way for the body to hold and pass urine. There are several options. Each procedure has advantages and disadvantages.
Some cancer doctors recommend chemotherapy before radical cystectomy. This is controversial. Cancer is less likely to return in some patients who receive chemotherapy before surgery. These patients may live longer. However, cancer doctors cannot predict which patients will get these benefits.
The other approach is to examine the bladder after surgery to see if a patient could benefit from chemotherapy. However, chemotherapy given after surgery may not be as effective as chemotherapy before surgery.
In some people who have very localized, less aggressive tumors, doctors may remove only the diseased part of the bladder.
One alternative to surgery is radiation therapy combined with chemotherapy. Only certain patients qualify for this approach. The advantage is the potential to keep your bladder. However, doctors don't know whether it is as effective as surgery.
This approach should be considered if a patient is not a good candidate for surgery.
More extensive tumors
Radical cystectomy is usually used to remove bladder cancer that has invaded beyond the bladder wall. If the entire tumor cannot be removed, chemotherapy or radiation therapy can shrink the tumor. It may then be removed surgically.
Sometimes cancer invades through the bladder wall or spreads to lymph nodes. Chemotherapy after surgery may reduce the chance that this cancer will come back. However, bladder cancers that have spread to lymph nodes usually cannot be cured.
Metastatic bladder cancer
Bladder cancer that has spread to other organs or to distant lymph nodes is considered metastatic. Metastatic bladder cancer is usually fatal. Chemotherapy can help patients with metastatic bladder cancer live longer. A small number of patients may even be cured.
Important follow up
Patients who have had bladder cancer continue to have an increased risk of developing cancers in and around the bladder. Patients should be closely monitored for the rest of their lives.
Call your doctor immediately if:
You notice blood in your urine
Your urine turns the color of rust
You begin to urinate more often than normal
Urination is painful or uncomfortable