Bladder Cancer Treatment and Survival Rate

November 25, 2024

This page was reviewed under our medical and editorial policy by Kevin G. Chan, M.D., clinical professor, division of urology and urologic oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

Following a bladder cancer diagnosis, the care team works with the patient to develop a treatment plan based on such factors as the cancer stage and the patient’s overall health and preferences.

Bladder Cancer Surgery

Surgery is typically the main treatment for most bladder cancer patients. The care team may perform one of the surgery types listed below.

Transurethral resection of the bladder (TURBT): 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 are able to surgically remove it or burn it off using an electric current.

Partial cystectomy: In some cases, the doctor may remove only part of the bladder in a procedure called partial cystectomy. Doctors often choose 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, nearby lymph nodes, part of the urethra and nearby organs that may contain cancer cells. In men, the nearby organs that may be 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 must also perform a reconstructive procedure to divert urine flow.

Urinary Diversion

Many patients 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 may be done intracorporeally or extracorporeally.

The most common options include those listed below.

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 ileal conduit is brought out of the body through an abdominal opening called a stoma. The stoma is covered by an external bag that 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 out of the body 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 sometimes have to self-catheterize to drain urine from the neobladder.

Intravesical Therapy

Intravesical therapy is a treatment where liquid medication is injected directly into the bladder to destroy cancer cells. There are two types of intravesical therapy: one using immunotherapy drugs and the other using chemotherapy drugs.

During intravesical therapy, a catheter, or thin tube, is inserted through the urethra and into the bladder. The medication is then inserted into the catheter, allowing it to directly come in contact with the bladder cancer cells.

This treatment is only used on surface-level cells that come into direct contact with the liquid medicine. It is primarily used for Stage 0 or Stage 1 bladder cancers that have not spread into the muscle wall. Intravesical therapy may also reduce the risk of recurrence in patients when given after a TURBT, especially if administered right away after surgery.

Chemotherapy

Chemotherapy treatment uses medication to destroy cancer cells. It may be given intravesically into the bladder area only, or systemically to allow for the medication to enter the whole body. For systemic chemotherapy, patients take pills or have an intravenous (IV) tube inserted into a vein in the skin that allows for the flow of medication into the bloodstream.

Chemotherapy may be used at several different points during treatment. Neoadjuvant therapy is the use of chemotherapy before surgery, and it may be used in muscle-invasive bladder cancers. It is used to decrease the size of the tumor, making it easier to remove. It may also lower the risk of recurrence.

Chemotherapy may also be given after surgery to help destroy any cancer cells that were not able to be surgically removed. This is called adjuvant therapy, and it may also be used in locally advanced muscle-invasive bladder cancer types.

In some cases, chemotherapy may be given alongside radiation therapy to increase its success. This is known as chemoradiation, and it may be used in older patients as an alternative to surgery.

In Stage 4 cancers, chemotherapy may be used as a standalone treatment. In some cases, this may be used to reduce a patient’s discomfort or side effects. This is known as palliative chemotherapy.

The type of chemotherapy drugs used varies depending on the cancer’s type, the patient’s overall health, whether or not it is being combined with radiation and other factors.

Chemotherapy drugs for bladder cancer may include:

• Platinol^® (cisplatin)
• Gemzar^® (gemcitabine)
• Velban^® (vinblastine)
• Adriamycin^® and Rubex^® (doxorubicin)
• Methotrexate

Side Effects of Chemotherapy for Bladder Cancer

Chemotherapy may cause side effects in bladder cancer patients, including:

• Frequent infections
• Hair loss
• Loss of appetite, diarrhea and/or constipation
• Feeling sick to the stomach and/or vomiting
• Loss of appetite
• Tiredness
• Frequent bruising or bleeding
• Sores developing in the mouth

While chemotherapy side effects may be unpleasant, not all patients will experience all side effects. A patient’s health care team will help manage side effects throughout treatment.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may be 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 bladder cancer symptoms

Side Effects of Radiation Therapy for Bladder Cancer

Patients undergoing radiation may experience side effects, including:

• Changes in bladder function, including an increased frequency in urination, blood in the urine or discomfort when urinating
• Incontinence
• Fatigue
• Increased risk of infection, bleeding or bruising
• Diarrhea or blood in stool
• Vomiting or upset stomach
• Skin irritation or blistering near the site of radiation
• Damage to tissue in and around the bladder
• Erectile dysfunction

Not all patients will experience each side effect, and their care team is always ready to assist with side effect management.

Immunotherapy

Immunotherapy uses medication to boost the immune system’s ability to find and destroy bladder cancer cells. It may be administered in several ways.

During intravesical immunotherapy, treatment is administered directly to the bladder. Two medications may be used for this.

• Adstiladrin^® (nadofaragene firadenovec) is a virus that delivers an immune-boosting protein to the cells in the bladder wall.
• Bacillus Calmette-Guérin (BCG) is a type of bacteria that activates an immune response to improve the ability to destroy cancer cells.

Another type of immunotherapy relies on immune checkpoint inhibitors. These target immune proteins, called checkpoints. Checkpoints regulate the immune system, stopping it from being too powerful. However, this regulation may also reduce the body’s ability to destroy cancer cells.

By taking immune checkpoint inhibitor drugs, checkpoints on the cells may be switched off to help the immune cells generate a stronger immune response, helping to destroy cancer cells more successfully.

Immune checkpoint inhibitor medications may include:

• Keytruda^® (pembrolizumab)
• Opdivo^® (nivolumab)
• Bavencio^® (avelumab)

Side Effects of Immunotherapy for Bladder Cancer

Immunotherapy for bladder cancer may cause side effects. While these side effects may be bothersome, the health care team is trained to assist with easing discomfort.

Side effects may vary depending on the type of immunotherapy given, but they may include:

• Fatigue
• Fever
• Skin rash or irritation
• Appetite loss
• Stomach or bowel discomfort
• Increased risk of infection
• Shortness of breath

Targeted Therapy

Targeted therapy uses medication to target cells on a genetic level. This may help control the growth and spread of bladder cancer cells. This treatment type is able to specifically target factors such as proteins, blood vessel cells or certain genes that help fuel the growth of cancer cells. Targeted therapy medication targets those specific factors to either destroy cancer cells or turn off genetic signals that boost cancer cell growth.

Targeted therapy may be used as a secondary treatment after chemotherapy for cancers that are locally advanced or have metastasized (spread), but suitability for this treatment will depend on the cancer’s genetic makeup.

Two types of targeted therapy are used for bladder cancer — fibroblast growth factor receptors (FGFR) inhibitors and antibody-drug conjugates (ADCs).

FGFR inhibitors target a type of protein, the fibroblast growth factor, that is found in some bladder cancers and fuels their growth. FGFR plays a role in cell division and tissue repair in the body. In patients with certain genetic mutations to the FGFR3 or FGFR2 genes, FGFR inhibitor treatment may be used. It is usually used after chemotherapy treatment.

The medication used for this treatment is Balversa® (erdafitinib).

ADCs are a type of chemotherapy drug that is made more powerful through the use of immunotherapy. In this treatment, a chemotherapy medication is connected to a type of immune system antibody that is able to specifically target cancer cells. For this reason, ADCs may be able to more precisely locate cancer cells and deliver chemotherapy medication to those areas, compared to the chemotherapy medicine on its own. ADC medications may include:

• Trodelvy^® (sacituzumab govitecan)
• Padcev^® (enfortumab vedotin)

Side Effects of Targeted Therapy for Bladder Cancer

Like all bladder cancer treatments, targeted therapy may cause side effects. These may vary depending on the type of treatment given, but side effects may include:

• Fatigue
• Nausea
• Skin rash, irritation or dryness
• Hair loss
• Changes to appetite or sense of taste
• Abdominal discomfort
• Low blood cell counts
• Eye problems, including retina or cornea problems and eye inflammation
• Swelling, redness or discomfort in the feet or hands
• Changes to the nails or nail bed
• Low sodium levels

Bladder Cancer Survival Rate

Bladder cancer survival rates are estimates based on how many patients are still alive five years after their initial cancer diagnosis compared to people without that cancer type.

However, it’s important to remember that new treatment innovations are continuously improving bladder cancer survival rates.

The overall five-year relative survival rate for bladder cancer is 78%, according to the American Cancer Society, which relies on data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database.

This data is further broken down by each stage of bladder cancer. In situ means the cancer cells are only found in the inner lining of the bladder; localized means the cancer cells are contained within the bladder; and regional refers to cancer cells that have spread outside the bladder and into nearby areas. Distant cancer is when the cancer has gone beyond the bladder and nearby areas into farther body areas.

• In situ: 96%
• Localized: 71%
• Regional: 39%
• Distant: 8%

Every patient’s health and prognosis is unique, so it is important for patients to review this information with their doctor.

Bladder Cancer Treatment at City of Hope

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.

“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