The choice of an appropriate treatment is based on the stage of the tumor, the severity of the symptoms and the presence of other medical conditions. Bladder cancer treatment may include:
Surgery, chemotherapy and radiation
Generally, stage 0 and I tumors are treated by removing the tumor without removing the rest of the bladder. They sometimes may also be treated by administering chemotherapy or immunotherapy directly into the bladder. Because the risk of the cancer returning is so high, people with bladder cancer require constant follow-up for the rest of their lives.
The treatment for patients with stage II and stage III disease is changing. While the accepted treatment has been removing the entire bladder (in a surgery called radical cystectomy), there is growing interest in keeping as much of the bladder as possible. Some patients may be treated by removing only part of the bladder, and that procedure is followed by radiation and chemotherapy. Some patients may be treated with chemotherapy before surgery, to try and shrink their tumor down, so that they might be able to avoid having the entire bladder removed. However, many people with stage II and stage III tumors still require bladder removal. In some patients with stage III tumors who choose not to have surgery, or who cannot tolerate surgery, a combination of chemotherapy and radiation may be used.
Most patients with stage IV tumors cannot be cured and surgery is not indicated. In these patients, chemotherapy is often considered.
Bladder cancers are often treated by immunotherapy, in which a medication causes your own immune system to attack and kill the tumor cells. Immunotherapy for bladder cancer is usually performed using Bacille Calmette-Guerin (commonly known as BCG), which is a solution of genetically changed tuberculosis bacteria. Because they were genetically modified, these bacteria are not able to produce infection. BCG is administered through a Foley catheter directly into the bladder. Since BCG is a biological agent, special precautions must be taken during its handling and administration.
Transurethral resection of the bladder (TURB)
People with stage 0 or I bladder cancer are usually treated with transurethral resection of the bladder (TURB). This surgical procedure is performed under general or spinal anesthesia. A cutting instrument is then inserted through the urethra to remove the bladder tumor.
Many people with stage II or III bladder cancer may require bladder removal (radical cystectomy). Partial bladder removal may be performed in some patients. Removal of part of the bladder is usually followed by radiation therapy and chemotherapy to help decrease the chances of the cancer returning. For those patients who undergo complete bladder removal, chemotherapy is also given after surgery to decrease the risk of a recurrence.
A urinary diversion surgery (a surgical procedure to create an alternate method for urine storage) is usually performed with the radical cystectomy procedure. Another surgical option is creation of a neobladder or "new bladder" to allow the body to store and empty urine.
As part of our comprehensive services, Norton Cancer Institute also gives patients the opportunity to participate in innovative National Cancer Institute and industry-sponsored clinical research studies. A list of studies is available by calling the downtown Louisville Norton Cancer Institute Resource Center at (502) 629-5500.
Support and Ongoing Care
The Norton Cancer Institute Resource Centers offer a variety of support services that address the emotional, physical and spiritual needs of cancer patients and their loved ones. The center houses a library of educational resources about prevention and detection, treatment options and recovery. Specially trained oncology nurses are available to provide one-on-one educational counseling for patients and family members. Email us at firstname.lastname@example.org and we will research and respond to your question within 48 hours. Exceptions may include weekends and holidays. Most questions are answered within one business day.
You may also call the downtown Louisville Norton Cancer Institute Resource Center at (502) 629-5500.