Bladder Cancer

Most people with bladder cancer will receive surgery at some point during their treatment. 

Surgery can have two different focuses: to identify whether the cancer has spread to the muscle layer of the bladder and remove abnormal tissue through a transurethral resection of bladder tumour (TURBT) or to treat the cancer by removing all or part of the bladder (known as a cystectomy). To find out if the bladder cancer has spread to lymph nodes in your pelvis and the stage (extent) of your cancer, one or more of these lymph nodes will be removed and looked at under the microscope.

Transurethral resection of bladder tumour (TURBT)

A transurethral resection of bladder tumour (TURBT) is a procedure which focuses on identifying the presence of bladder cancer and whether it has spread to the muscle layer of the bladder. TURBT is also a treatment option for non-muscle invasive bladder cancer. During this procedure, a surgical oncologist inserts a hollow tube with a camera attached (known as a cystoscope) into the bladder through the urethra. The cancerous tissue down to the muscle layer of the bladder wall is then removed with a small wire loop, laser or high-energy electricity (known as a fulguration).

Cystectomy

Cystectomy refers to the surgical removal of part or all of the bladder to treat bladder cancer. A cystectomy is typically performed for muscle-invasive bladder cancer which has spread to the muscle layer of the bladder wall.

Rarely, a partial cystectomy may be performed which removes only the cancerous tissue within the bladder. People who undergo this procedure will not need reconstructive surgery, however their bladder will have a reduced capacity to hold urine.

A radical cystectomy involves the removal of the entire bladder and surrounding lymph nodes, in addition to surrounding organs such as the prostate and seminal vesicles in men and the reproductive organs in women. It is a treatment option for people who have large bladder tumours or that have cancer in more than one part of the bladder.

Chemotherapy uses a range of drugs to kill and slow the growth of bladder cancer. There are two types of chemotherapy that you may receive. These are intravesical chemotherapy and systematic chemotherapy.

Learn more about chemotherapy and how it is delivered.

Intravesical chemotherapy

Intravesical chemotherapy delivers drugs directly into the bladder using a long and flexible tube called a catheter. It only targets the bladder lining and not surrounding areas. This makes intravesical chemotherapy suitable for non-muscle-invasive bladder cancer but not muscle-invasive bladder cancer. 

A round of intravesical chemotherapy is known as an instillation. This involves filling the bladder with anti-cancer drugs for up to two hours before draining it out. The number of instillations you receive depends on your risk type. For low-risk cancers, one instillation is typically given in combination with TURBT surgery. Medium risk cancers may be delivered weekly for six weeks. This might be repeated, followed by maintenance treatments for at least a year. 

Radiation therapy, also known as radiotherapy, is commonly used for muscle-invasive bladder cancer. It can be delivered after surgery or by itself instead of surgery, often in combination with chemotherapy (chemoradiation). Radiation therapy provides an alternative treatment option to surgery which preserves the bladder.

Types of radiation therapy commonly used for people with bladder cancer include:

Immunotherapy trains your body’s own immune system to recognise and fight bladder cancer cells.  

Bladder cancer cells can try to hide behind proteins known as checkpoints. Checkpoint inhibitors block these proteins, allowing the immune system to recognise and fight cancer cells. 

When you are diagnosed with bladder cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer. Common treatment options for each stage of bladder cancer include: