Bladder Cancer Treatment Options

“With bladder cancer, the majority of patients that I see can be cured; the challenge is to get patients the same quality of life that they had before surgery.”

Kevin Chan, M.D., head of reconstructive urology at City of Hope

City of Hope offers the latest advances in bladder cancer care. It begins with our comprehensive screening and diagnostic tools, and centers on our unique “coordinated care pathway” in which our multidisciplinary teams combine the latest research findings with outstanding patient care.

Surgery

Surgery is a common treatment option for most bladder cancer patients, particularly those with early-stage, localized cancer. Different procedures may be chosen based on the individual patient’s diagnosis. City of Hope surgeons are among the most experienced in the country and have excellent success rates using a range of advanced technologies.

We specialize in:

Minimally invasive robotic cystectomies with advanced urinary diversion techniques.
Urinary tract reconstruction and the treatment of erectile dysfunction, urinary incontinence and urologic retroperitoneal disease.

Surgical Procedures

The most effective surgical procedures depend on a cancer’s stage, including how large it is, and whether it has spread to other tissues.

Treatments include:

Local excision - This surgery (sometimes called a polypectomy) is used to remove precancerous polyps and very small cancers.
Transurethral resection - This minimally invasive surgical procedure, performed through the urethra, is most useful for removing those cancers that have not advanced beyond the lining of the bladder. In most low-grade, low-stage tumors, resection is all that is required. This procedure uses a thin, flexible tube (cystoscope) that is inserted into the urethra and guided into the bladder. After cancerous tissue is identified, tools inserted through the tube can surgically remove it or burn it off using an electric current.
Segmental or partial cystectomy - In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor often chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area. Because only part of the bladder is removed, the patient may urinate normally after recovery.
Radical cystectomy - For invasive bladder cancer, the most common type of surgery is radical cystectomy. The doctor may also choose this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes and part of the vagina are removed. Because the entire bladder is removed, the surgeon will also need to perform a reconstructive procedure to divert urine flow.
Urinary diversion - Many patients today who require the removal of the entire bladder are candidates for continent urinary diversion, a type of surgery that involves complete pelvic reconstruction that allows patients to recover normal urinary function.

What are the Types of Urinary Diversions?

Many patients today who require the removal of the entire bladder are candidates for continent urinary diversion, a type of surgery that involves complete pelvic reconstruction that allows patients to recover normal urinary function.

Depending on the disease, patient’s health, desired outcomes and quality-of-life goals, the surgeon may opt for one of several urinary diversion procedures following a radical cystectomy. Urinary diversions can be done intracorporeally or extracorporeally.

The most common ones include:

Ileal Conduit: The ureters (tubes that drain urine from the kidneys) are connected to a small segment of the ileum (small intestine). The end of the ileum conduit is brought out into the skin through an abdominal opening called a stoma. The stoma is covered by an external bag which collects urine as it drains from the conduit.
Indiana Pouch: This procedure creates an internal reservoir using the ileum and colon (large intestine), with a small part of the ileum brought to the skin as a stoma. The ureters empty into this pouch and the patient will regularly empty the pouch by passing a small, thin catheter through the stoma and into the pouch.
Neobladder: Some patients may be eligible for a neobladder procedure, which creates a pouch from the small intestine that is connected directly to the urethra. While this procedure allows patients to pass urine through the urethra, it may take a while to regain urinary control and patients may have to self-catheterize to drain urine from the neobladder.

City of Hope also has an extensive recovery and follow-up program for post-cystectomy patients, aimed at helping them:

Regain urinary control
Minimize the risk of complications
Address emotional, social and lifestyle issues related to the cancer or treatments

Specialists in this program include nurses, rehabilitation therapists, occupational therapists, clinical social workers, psychologists, psychiatrists, dieticians and other supportive care medicine experts.

Drug Therapy

Drug therapy may be given to patients to fight bladder cancer cells throughout the body by killing them or stopping their growth and spread. These drugs include:

Chemotherapy, which targets all rapidly dividing cells, including bladder cancer cells
Immunotherapy, which stimulates the patient’s immune system to attack cancer cells

Drugs may also be prescribed to treat conditions related to bladder cancer or its treatments, such as low blood cell counts, nausea or pain.

In addition to oral and intravenous delivery, bladder cancer patients may also receive anti-cancer drugs intravesically. In intravesical therapy, a catheter is guided through the urethra and into the bladder, allowing for direct drug administration. By directly delivering and confining the drugs within the bladder, its effectiveness may be increased and side effects can be limited.

The drug or drug combination used depends on the type and stage of bladder cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight bladder cancer while minimizing side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may delivered externally using focused beams of energy, or internally by placing a radiation-emitting substance placed in or near the tumor site.

Depending on the cancer, the patient’s health and desired outcomes, radiation therapy may be offered on its own or in conjunction with surgery and drug therapy. This includes:

Postsurgical treatment for surgeries that did not remove the whole bladder
Primary treatment for early-stage bladder cancer patients who can’t have surgery
Initial treatment for advanced bladder cancer, along with cancer-fighting drugs
Treatment to relieve symptoms associated with bladder cancer.

City of Hope offers a wide variety of leading-edge radiation therapy options to treat bladder cancer. These include image-guided external radiation systems (such as TomoTherapy or TrueBeam) that combine detailed imaging and radiation delivery technologies, allowing our care team to “sculpt” radiation beams to the tumor site while avoiding nearby healthy tissue. This maximizes radiation’s cancer-fighting ability while minimizing exposure to the bladder, rectum and other nearby organs.