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Treatment options

Invasive bladder cancer means the cancer cells have spread into or through the muscle layer of the bladder. It is also called muscle invasive bladder cancer.

This page is about how your doctor decides which treatment you need for invasive bladder cancer.

We have a separate section about treating early bladder cancer which is only in the inner lining and hasn’t spread into the muscle layer of the bladder wall.

The main treatments

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

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

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

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

You might have chemotherapy

  • before surgery or radiotherapy - this is called neoadjuvant chemotherapy 
  • alongside radiotherapy, to make the radiotherapy work better
  • after surgery - if you didn’t have it before - this is called adjuvant chemotherapy
  • as your main treatment, if your cancer is locally advanced or advanced

Surgery

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

This means you need a new way of collecting urine. You might need to wear a bag to collect urine from an opening on your abdomen (urostomy). Or in some cases, your surgeon can create a new bladder.

Your surgeon will talk through your surgery and how you will collect urine afterwards. You might have a choice of what way you can collect urine.  

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells.

You go into the hospital each weekday for 4 to 7 weeks to have the treatment.

Chemotherapy and radiotherapy (chemoradiotherapy)

You might have chemotherapy at the same time as radiotherapy. The chemotherapy drugs help the radiotherapy to work better. They are 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.

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 doctors consider many factors, including:

  • 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)
  • whether you have any carcinoma in situ (CIS) in your bladder
  • your general health and level of fitness
  • what cancer treatment you’ve had before
  • how much urine your bladder can hold
  • what symptoms you have from your cancer

Your doctor will talk to you about your treatment, its benefits and the possible side effects.

Choosing between surgery and radiotherapy

Your doctor might ask you to choose between surgery to remove your bladder or radiotherapy if both treatments are suitable for you.

But they might not recommend radiotherapy 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 the multidisciplinary team.

You may need to meet with one or more of the specialists in the team to discuss your options. You make the final decision about which treatment you have.

Treatment by stage

Localised invasive bladder cancer

Localised invasive bladder cancer means your cancer has grown into, but not through, the muscle layer of your bladder. It hasn’t spread to your lymph nodes or to other parts of your body.

Your doctor will offer you chemotherapy with a combination of drugs if it’s suitable for you. This is called neoadjuvant chemotherapy. You then have either:

  • surgery to remove your bladder (cystectomy)
  • radiotherapy combined with drugs that make it work better (radiosensitisers)

You might have chemotherapy after surgery if you didn’t have it before and your doctor thinks there is a high risk of your cancer coming back.

Locally advanced bladder cancer

Locally advanced bladder cancer means your cancer has grown through the muscle layer of your bladder into the fat layer. Or it has spread to nearby lymph nodes. It hasn’t spread to other parts of your body.

You usually have a combination of chemotherapy drugs.

You might have surgery or radiotherapy after your chemotherapy if your doctor thinks these treatments are suitable. Your team will talk to you before you start treatment and discuss whether they think this might be a possibility.                        

Advanced bladder cancer

Advanced bladder cancer means your cancer has spread to the wall of your tummy (abdomen) or between the hips (pelvis). Or it has spread to distant lymph nodes or to other parts of the body such as the bones, lungs or liver.

Treatment aims to control your cancer and give you a good quality of life. Your doctor might offer you:

  • a combination of chemotherapy drugs
  • treatments to control symptoms caused by your cancer, this may include surgery

Your doctor will discuss the advantages and disadvantages of having treatment with you. They will also talk to you about what might happen if you don’t have any treatment.

If the cancer comes back

If your cancer comes back after treatment your doctor calls this a recurrence or relapse. The treatment you have depends on:

  • where the cancer has come back
  • the treatment you had before
  • your general health and level of fitness
  • your wishes

Some common sites it may come back in are the lymph nodes, lungs, liver or bones.

After surgery

If invasive bladder cancer comes back after surgery you might have:

  • chemotherapy into a vein 
  • radiotherapy to the sites it has come back in

Unfortunately, if your cancer comes back after having a radical cystectomy it usually can’t be cured. Talk to your doctor or nurse about the treatments that are best for you.

After radiotherapy or chemoradiotherapy

If invasive bladder cancer comes back after radiotherapy you might have:

  • surgery to remove your bladder (cystectomy)
  • chemotherapy into a vein

You can't have more radiotherapy if your bladder cancer comes back after radiotherapy or chemoradiotherapy.

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 make existing treatments better and develop new treatments.

Last reviewed: 
29 Jul 2019
  • BMJ Best Practice. Bladder Cancer
    D Lamm and others
    BMJ Publishing Group Ltd, 2018

  • Bladder cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), February 2015

  • EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer
    J A Witjes and others
    European Association of Urology, 2017

  • Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up
    J Bellmunt and others
    Annals of Oncology, 2014. Volume 25, Issue 3, Pages 40-48

  • Bladder Preservation for Muscle-Invasive Bladder Cancer
    A Mirza and A Choudhury
    Bladder Cancer, 2016. Volume 2, Issue 2, Pages 151 – 163

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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