Types of treatment for invasive bladder cancer

Invasive bladder cancer means that the cancer cells have spread beyond the inner lining and into the muscle layer of the bladder. 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 into the muscle layer of your bladder you will need to have one of the following treatments

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

Giving chemotherapy before surgery or radiotherapy, or combining it with radiotherapy, can help these treatments to work better. The chemotherapy can also treat any cancer that has spread outside your bladder.

If you have surgery and there is a high risk of the cancer coming back afterwards, your doctor may recommend that you have chemotherapy to reduce the risk of recurrence.

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 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 radiologist, pathologist, surgeon, radiotherapy and chemotherapy doctors, 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. There is information about the different types of surgery for bladder cancer in this section. The techniques for surgery for bladder cancer have been improving over many years. 

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. 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

The main benefit of radiotherapy is that you don't need to have your bladder removed. The bladder usually shrinks though, so you may find that you need to pass urine more often. 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. 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 for some people. This is called concurrent chemoradiation. For some people it may cause more severe side effects during treatment than radiotherapy on its own. 

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%). 

Further information about invasive 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.