Bladder Cancer Treatment
Bladder cancer begins in the bladder, a hollow, muscular organ in the pelvis that stores urine until it is ready to be released from the body. In most cases, the cancer occurs when healthy cells in the inner lining of the bladder undergo harmful changes that cause them to grow rapidly and form tumors.
The precise causes of bladder cancer are not yet fully understood. However, researchers have identified several risk factors, including smoking, exposure to dangerous chemicals and chronic bladder infections. Symptoms can include bloody urine, painful urination, frequent urges to urinate and lower abdominal pain.
Bladder cancer is relatively common, particularly in older adults, with men facing a higher risk than women. Treatment may involve surgery, chemotherapy, radiation therapy and/or immunotherapy. Each option aims to eliminate the tumor or prevent it from growing and spreading.
The Right Diagnosis. Right Away.
If you've received an abnormal test result that could indicate cancer, request an appointment with our bladder cancer team today. Moffitt's diagnostic experts will perform the tests needed to diagnose or rule out cancer so you can know for sure.
Moffitt has the highest quality imaging technology and uses the least invasive testing procedures to give you accurate results.
Surgery for bladder cancer
The goal of bladder cancer surgery is to remove as much cancerous tissue as possible. The optimal surgical approach can vary based on the size and stage of the tumor and other factors. The types of bladder cancer surgery include:
Transurethral resection of bladder tumor (TURBT)
For early-stage, noninvasive bladder cancer, a TURBT procedure may be considered. This minimally invasive surgery involves removing the tumor with a thin, rigid, tube-shaped medical instrument with a lens and light attached to the end (resectoscope), which is inserted through the urethra and guided into the bladder. The surgeon may treat any remaining cancer cells with fulguration, which involves using a high-energy laser to burn the cells.
Segmental cystectomy
If the tumor has invaded the bladder muscle but remains confined to one small area, a segmental cystectomy may be performed. This procedure involves removing only the cancerous section of the bladder wall and some nearby lymph nodes. After surgery, the remaining portion of the bladder will continue to function normally.
Radical cystectomy with extended lymph node dissection
For an extensive tumor that affects multiple areas of the bladder, a radical cystectomy may be performed to remove the entire bladder along with some surrounding lymph nodes. If the patient is male, the surgeon may also remove the prostate; if the patient is female, the surgeon may also remove the ovaries, fallopian tubes, uterus and part of the vagina.
Robotic-assisted radical cystectomy
Using a combination of high-definition, three-dimensional (3D) magnification, advanced robotic technology and miniature surgical instruments, a surgeon can remove the cancerous bladder with heightened precision. Compared to traditional surgery, robotic surgery typically involves smaller incisions, less scarring and a quicker recovery.
Reconstructive surgery
If the bladder is removed, the surgeon will perform a urinary diversion procedure to create a new way for the body to store and eliminate urine. If the urethra remains intact, the surgeon may create a new bladder (neobladder) using a section of the patient’s bowel and then connect it to the ureters and urethra during bladder reconstruction surgery.
Florida's Cancer Center of Excellence
Moffitt is a Cancer Center of Excellence by the state of Florida. The designation recognizes providers that exceed service standards and excel in providing quality, comprehensive and patient-coordinated care.
Radiation therapy for bladder cancer
Radiation therapy delivers high-energy particles or waves directly to a tumor site to damage the DNA of cancer cells and ultimately destroy them or disrupt their growth. Two main types of radiation therapy can be used for bladder cancer:
External beam radiation therapy (EBRT)
A noninvasive treatment, EBRT uses an external machine (linear accelerator) to create and precisely focus high-energy X-rays on a tumor in the bladder, minimizing the impact on the surrounding healthy tissues. Typically, EBRT is delivered over several sessions and may be combined with chemotherapy for enhanced effectiveness.
Brachytherapy
A form of internal radiation therapy, brachytherapy for bladder cancer involves the surgical placement of a small radioactive source, such as a seed or wire, directly inside or near a tumor. This targeted approach can deliver a high dose of radiation to cancerous cells while limiting any exposure to the surrounding healthy tissues. Brachytherapy is less commonly used for bladder cancer than EBRT but may be considered for specific cases.
Usually, radiation therapy is not the primary treatment for bladder cancer. More often, it is used in combination with other therapies, such as surgery and chemotherapy, for heightened treatment effectiveness. However, if surgery is not an option or the patient is unable to receive chemotherapy, radiation therapy might be used on its own to reduce symptoms, such as pain and bleeding, by shrinking the tumor.
Chemotherapy for bladder cancer
Chemotherapy uses potent medications to destroy cancerous cells or stop them from growing. Chemo can be used before surgery to shrink a tumor and make it easier to remove or after surgery to reduce the risk of cancer recurrence.
Systemic chemotherapy
If the cancer has spread beyond the bladder, systemic chemotherapy may be considered. The chemo medications may be administered intravenously or orally. The goal is to eliminate widespread cancer cells and improve the patient’s outcome and quality of life.
Intravesical chemotherapy
In some cases, liquid chemotherapy drugs such as gemcitabine (Gemzar®) and docetaxel (Taxotere®) may be delivered directly into the bladder. Known as intravesical therapy, this approach can target cancer cells in the lining of the bladder while minimizing any side effects of treatment.
Immunotherapy for bladder cancer
Immunotherapy is a cancer treatment that boosts the ability of the body’s immune system to target and destroy cancerous cells. The types of immunotherapy for bladder cancer include:
Intravesical immunotherapy
A possible treatment option for early-stage, non-muscle-invasive bladder cancer, intravesical immunotherapy is administered directly into the bladder via a catheter. One example is Bacillus Calmette-Guerin (BCG) therapy, a cancer vaccine that can train the immune system to recognize and attack cancer cells. BCG uses a weakened strain of the tuberculosis bacterium, which may be administered after tumor removal to help prevent recurrence.
Another example of intravesical immunotherapy for bladder cancer is nadofaragene firadenovec (Adstiladrin), a gene therapy that uses a modified virus to deliver immune-activating proteins to the cells lining the bladder wall. This can stimulate the immune system to target and destroy cancer cells within the bladder.
Checkpoint blockade immunotherapy
Checkpoints are proteins on healthy cells that interact with proteins on certain immune cells (T cells) to prevent an immune response. Some cancer cells exploit these checkpoints to evade the immune system. Immune checkpoint inhibitors are drugs that block the proteins on cancer cells from binding to T cells, allowing the immune system to recognize and attack bladder cancer cells more effectively.
Preserve Your Bladder with a Personalized Approach to Advanced Bladder Cancer
Bladder removal is not the only path forward for everyone with muscle-invasive bladder cancer. At Moffitt Cancer Center, we offer bladder preservation therapy, an advanced treatment strategy that allows select patients to maintain bladder function without compromising cancer control. This approach combines surgery to remove the tumor, radiation to target cancer cells, and low-dose chemotherapy to enhance treatment effectiveness — all while avoiding the life-altering impact of radical cystectomy.
Our multidisciplinary bladder cancer team carefully evaluates each patient to determine the best course of care tailored to their specific diagnosis and health profile. For eligible individuals with specific low-risk disease characteristics, this bladder-sparing option can offer the same level of cancer control as bladder removal surgery, but with potentially fewer side effects and a better quality of life. If you've been diagnosed with muscle-invasive bladder cancer, ask your doctor if bladder preservation might be right for you, or schedule a consultation with our expert team.
Frequently asked questions (FAQs) about bladder cancer treatment
The following FAQs-related articles provide additional information about bladder cancer treatment:
- What are three things to know about bladder cancer treatment?
- How serious is bladder cancer surgery?
Benefit from world-class care at Moffitt Cancer Center
Moffitt’s comprehensive Urologic Oncology Program offers a full range of treatment options for bladder cancer. We are proud to be the first hospital in the southeastern United States to utilize the advanced Image1 S™ SAPHIRA™" system in combination with the Cysview® Blue Light Cystoscopy imaging agent to illuminate cancer cells. Cysview Blue Light Cystoscopy uses blue and white light along with a locally instilled imaging agent to provide the surgeon with next-level visualization, which can enhance the detection and treatment of non-muscle-invasive bladder cancer and reduce the risk of recurrence.
Moffitt also hosts a robust portfolio of clinical trials, providing our patients with unique opportunities to try groundbreaking therapies as soon as they become available. Examples include the latest intravesical immunotherapies, chemotherapies with gemcitabine and docetaxel and minimally invasive robotic procedures.
If you would like to learn more about bladder cancer treatment, you can request an appointment with a specialist at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.
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