Treatment Plan

The choice of treatment depends on the patient's age, overall health and tolerance for side effects, as well as the type of cancer and its stage. The four main treatment options are surgery, chemotherapy, radiation and biologic treatment. Sometimes a combination of these methods is used.

Surgery

Transurethral resection. This method is used in early stage bladder cancer when the tumor is localized. A tiny telescopic camera, called a cystoscope, is passed through the urethra when the patient is under local or general anesthesia. The cystoscope uses fiberoptic light source to allow the doctor to see the inside of the bladder. Once the tumor is located, guided tools are used to remove the tumor and to biopsy additional areas that look suspicious for cancer. Superficial tumors can be fulgurated (cauterized) or treated with a laser. The abdomen does not need to be opened.

Cystectomy. In more advanced bladder cancer, the bladder tumor and underlying structures are removed through an abdominal incision. While the patient is under local or generalized anesthesia, the surgeon opens the abdomen and the bladder to expose the tumor. Some surgeons preserve bladder function by removing only part of the bladder if the tumor is locally invasive but isolated. If the tumor is extensive, the entire bladder is removed.

Reconstructive surgery. A urostomy is an opening for urine to pass from the kidneys to the outside of the body through an artificial passageway. Sometimes a length of small intestine or colon is used to create a passage from the urinary tract to the abdomen. Other times the urine is made to flow continuously out through the urostomy opening into a small pouch that must be emptied. A "continent diversion" urostomy procedure does away with the pouch. Instead, a valve enables the length of intestine to hold urine until the patient empties it using a drainage tube (catheter). There are other bladder reconstructive methods that preserve normal urine flow to some degree.

Biologic therapy

Biologic therapy stimulates the patient's own immune system to fight cancer. BCG (Bacillus Calmette-Guerin) vaccine, used in some countries against tuberculosis and named after the scientists who developed it, has proven to be very effective in preventing recurrence of bladder cancer following transurethral surgery. BCG is instilled in the bladder for two hours, and then the patient urinates. It is given once a week for six weeks.

Radiation therapy

External beam radiation uses X-ray energy to destroy cancer cells. This method is usually reserved for patients with advanced bladder cancer that would not tolerate surgery. Recent research suggests that it can be an alternative to a cystectomy.

Chemotherapy

Chemotherapy is the use of anti-cancer medications, given either intravenously or by mouth, to destroy or disable cancer cells anywhere in the body. Chemotherapy is usually given to patients with advanced bladder cancer, sometimes together with radiation treatment.

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This article was reviewed and updated June 2007.