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Types of treatment for invasive bladder cancer

 Men and women discussing bladder cancer

This page tells you about treatment for bladder cancer that has spread into the bladder muscle. There is information about

 

A quick guide to what's on this page

Types of treatment for invasive bladder cancer

Radiotherapy or surgery are the main treatments for bladder cancer that has spread into the muscle layer of your bladder. You may have one of the following treatments

  • Surgery to remove all or part of the bladder
  • Radiotherapy on its own, or combined with chemotherapy (chemoradiation)

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

Choosing between surgery or radiotherapy

In some situations surgery or radiotherapy work equally well in treating invasive bladder cancer. You and your specialist will need to talk about the risks and benefits of each treatment in your particular case. The main difference is that having radiotherapy means you can keep your bladder. But it can cause side effects such as diarrhoea or inflammation of the bladder during the treatment.

Surgery for invasive bladder cancer usually means having quite a big operation. There are different types of bladder cancer surgery. You may have part or all of the bladder removed. If you need to have your whole bladder removed, you may need to have a bag (urostomy bag) on your tummy (abdomen) afterwards to collect urine. Some people can have an operation to create a new bladder instead so that they can pass urine in the usual way.

 

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What invasive bladder cancer is

Invasive bladder cancer means that the cancer cells have spread beyond the inner lining of the bladder and into the muscle layer. There is a risk that the cancer could spread to other areas of the body if it is not treated.

If your cancer has spread from where it started in your bladder to somewhere else this is called advanced bladder cancer.  You can read more about treatment for advanced bladder cancer in our section about treating advanced bladder cancer.

 

The main treatments

If your cancer has spread into the muscle layer of your bladder you may need to have one of the following treatments

Giving chemotherapy before surgery or radiotherapy, or combining it with radiotherapy, can help these treatments to work better.  Chemotherapy before surgery or radiotherapy is called neoadjuvant chemotherapy. Chemotherapy combined with radiotherapy is called chemoradiation. If you have a high risk of the cancer coming back after surgery, your doctor may recommend that you have chemotherapy after surgery. This is to reduce the risk of recurrence and is called adjuvant chemotherapy.

If you are having radiotherapy and you are well enough, your doctor may offer you chemoradiation. But if your doctor does not think you are fit enough to have the combination of chemotherapy with radiotherapy, they may offer you radiotherapy on its own. 

For cancers that are only in the surface layer of the muscle (T2a cancers) doctors may just remove the tumour in an operation called a TURBT. They then give chemotherapy combined with radiotherapy (chemoradiation). This treatment is called multimodality bladder preserving treatment. It means that people can keep their bladder.

 

Choosing between surgery and radiotherapy

Surgery or radiotherapy work equally well for most types of invasive bladder cancer. But radiotherapy is not recommended in the following situations

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

You will need to talk to your specialist about the risks and benefits of surgery or radiotherapy in your particular case. Your doctor will discuss your treatment options with a team of people who specialise in treating bladder cancer (the multidisciplinary team). The team includes a pathologist, surgeon, radiotherapy and chemotherapy doctors, a therapy radiographer and specialist nurses. You may need to meet with one or more of these specialists to discuss your options. The team will recommend the best options to treat your cancer. The final decision about which treatment you have is up to you.

Surgery

Surgery for invasive bladder cancer means having quite a big operation. You usually have all of the bladder removed (cystectomy). In some rare cases, you may have part of the bladder removed (partial cystectomy). There is information about the different types of surgery for bladder cancer in this section. 

If you need to have your whole bladder removed, you may be able to have an operation to create a new bladder. With some operations you have to have a waterproof bag (urostomy bag) on your tummy (abdomen) to collect the urine afterwards. 

If the cancer comes back after surgery

In 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 a couple of years or 5 or more years later. You will then need to have further treatment with either chemotherapy into a vein or radiotherapy to the bladder area. You will need to talk to your doctor about these different treatments to find out which they think will be best for you. 

Radiotherapy

Radiotherapy means going into the hospital each weekday for 6 to 7 weeks to have the treatment, which can be very tiring. Radiotherapy can also cause short term inflammation of the bowel, which can cause diarrhoea and may be long term for some people. You may also have inflammation of the bladder during the treatment, which may make it uncomfortable to pass urine. The bladder usually shrinks, so you may find that you need to pass urine more often. The main benefit of radiotherapy to the bladder is that you don't need to have your bladder removed. There is detailed information about radiotherapy for bladder cancer in this section. 

Combined chemotherapy and radiotherapy

Giving chemotherapy and radiotherapy at the same time has been shown to work better than radiotherapy on its own. This is called chemoradiation. The chemotherapy drugs are sometimes called radiosensitisers as they help the radiotherapy to work better. For some people it may cause more severe side effects during treatment than radiotherapy on its own. But doctors can choose from a variety of chemotherapy drugs with different side effects.

For chemoradiation, you have radiotherapy as normal, and you also have chemotherapy at the same time. You usually have the chemotherapy during the first and fourth week of radiotherapy. But there are different drugs and way of giving these drugs. You can read more about chemoradiation on the page about radiotherapy for bladder cancer

If the cancer comes back after radiotherapy or chemoradiotherapy

In around 1 in 3 people (30%) who have radiotherapy on its own for bladder cancer, the cancer comes back in the bladder area some time later. If this happens you will need to have surgery to remove the bladder because you will not be able to have more radiotherapy. In people who have chemoradiation the cancer comes back in fewer people. Depending on how deeply the cancer has gone into the bladder wall it may come back in around 1 in 5 people (18%) to 1 in 3 people (30%). 

 

More information about bladder cancer treatments

Your own doctor can give you information about the treatment options in your particular case. But in this section there is detailed information about all these treatments for invasive bladder cancer to help you discuss them and make up your mind which to have.

bladder cancer clinical trials

 

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Updated: 4 August 2015