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Treatment decisions

Find out about making treatment decisions for cancer that has spread into the bladder muscle.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

The main treatments

You might have one of the following treatments for invasive bladder cancer:

  • surgery to remove all or part of the bladder (cystectomy)
  • radiotherapy
  • radiotherapy combined with chemotherapy (chemoradiation)

Having chemotherapy before surgery or radiotherapy, or combining it with radiotherapy can help these treatments work better.


You might have chemotherapy before surgery or radiotherapy, this is called neoadjuvant chemotherapy. Your doctor might recommend that you have chemotherapy after surgery, if you have a high risk of the cancer coming back. This is called adjuvant chemotherapy.


You might have chemotherapy at the same time as radiotherapy, this is called chemoradiation. You might have radiotherapy on its own if your doctor does not think you are fit enough for chemoradiation at this time.


Surgery to remove all or part of your bladder is a big operation.You might have an operation called trans urethral removal of bladder tumour (TURBT) if you have cancer that is only in the surface layer of the muscle (stage T2a). You will then have chemotherapy combined with radiotherapy (chemoradiation). 

Choosing between surgery and radiotherapy

Surgery or radiotherapy work equally well for most types of invasive bladder cancer. But radiotherapy is not recommended if:

  • you have squamous cell bladder cancer
  • there is carcinoma in situ (CIS) in much of the bladder lining as well as invasive cancer
  • initial chemotherapy is not working
  • the cancer is blocking one or both of the tubes that carry urine into the bladder from the kidneys (ureters)

Talk to your specialist about the risks and benefits of surgery or radiotherapy for you. They will discuss your treatment options with your multidisciplinary team.

You may need to meet with one or more of the specialists in the team to discuss your options. They will team will recommend the best options to treat your cancer you. You take the final decision about which treatment you have.


Surgery for invasive bladder cancer means having quite a big operation. You usually have all of the bladder removed (cystectomy).

You may be able to have an operation to create a new bladder if you need a cystectomy. After some of these operations you need to have a waterproof bag (urostomy bag) on your tummy (abdomen) to collect your urine afterwards.

Some people have part of the bladder removed (partial cystectomy) but this is rare.

If the cancer comes back after surgery

For around 1 in 2 people (50%) who have surgery for invasive bladder cancer, the cancer comes back in the bladder area some time later. The cancer may come back within the first two years, or 5 or more years later.

Invasive bladder cancer that comes back after surgery is treated with either chemotherapy into a vein or radiotherapy to the bladder area. Talk to your doctor about these different treatments to find out what is best for you.


Having radiotherapy to the bladder means that you don't need to have your bladder removed. But with radiotherapy you go into the hospital each weekday for 6 to 7 weeks to have the treatment. This can be very tiring.

Radiotherapy can also cause uncomfortable side effects. These may include:

  • inflammation of the bowel, which can cause diarrhoea and may be long term for some people
  • inflammation of the bladder, which may make it uncomfortable to pass urine
  • your bladder shrinking, which means you may need to pass urine more often


Giving chemotherapy and radiotherapy at the same time has been shown to work better than radiotherapy on its own. This treatment is called chemoradiation.

The chemotherapy drugs help the radiotherapy to work better. They are sometimes called radiosensitisers.

You usually have the chemotherapy during the first and fourth week of radiotherapy. There are different drugs and different ways of giving these drugs.

For some people this treatment may cause more severe side effects than radiotherapy on its own. But doctors can choose from a variety of chemotherapy drugs with different side effects.

If the cancer comes back after radiotherapy or chemoradiotherapy

For around 1 in 3 people (30%) who have radiotherapy for bladder cancer, the cancer comes back some time later.

Bladder cancer comes back in fewer people who have chemoradiation. Depending on how deeply the cancer has gone into the bladder wall, it may come back in around 1 in 5 people (18%) or 1 in 3 people (30%).

You can't have more radiotherapy if your bladder cancer comes back after radiotherapy or chemoradiotherapy. You usually have surgery to remove the bladder (cystectomy).

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:

  • making existing treatments better
  • developing new treatments
Last reviewed: 
04 Aug 2015
  • Bladder cancer

    DS Kaufman, WU Shipley, AS Feldman, 2009

    The Lancet, Volume 374, Issue 9685

  • Bladder cancer: diagnosis and management

    National Institute for Health and Care Excellence (NICE), February 2015

  • MDT Guidance for Managing Bladder Cancer Algorithms

    British Uro-oncology Group (BUG), January 2013

  • Muscle-invasive and Metastatic Bladder Cancer

    European Association of Urology, 2015

  • Radiotherapy with or without Chemotherapy in Muscle-Invasive Bladder Cancer

    ND James and others, 2012

    The New England Journal of Medicine, Volume 366

  • Similar treatment outcomes for radical cystectomy and radical radiotherapy in invasive bladder cancer treated at a United Kingdom specialist treatment centre

    S Kotwal and others,  2007

    International Journal of Radiation Oncology Biology Physics, Volume 70, Number 2

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