Bladder Cancer

Understanding treatment for bladder cancer and how it is delivered

Last modified: February 10, 2022

What are the treatment options for bladder cancer? Treatment options

The primary treatment options for bladder cancer include surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy and trimodal therapy. The type of treatment you receive will depend on a number of different considerations, such as the type of bladder cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how bladder cancer treatment works in the private health system.

Types of bladder cancer treatmentTypes of treatment

Surgery for bladder cancerSurgery

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 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.

Open cystectomy

Where a long incision is made in the abdomen to remove the cancerous tissue.

Keyhole (laparoscopic) cystectomy

A minimally invasive procedure that uses several small incisions to access the bladder. Laparoscopic procedures result in less postoperative pain and complications, shorter hospital stay and faster recovery compared to open cystectomy.

Robotic-assisted cystectomy

Uses a robotic system to perform a keyhole cystectomy remotely, allowing greater precision in comparison to standard keyhole surgery.

If the entire bladder is removed, reconstructive surgery will be required which may include incontinent diversion (resulting in a stoma – an opening that can divert urine through the body), continent diversion (which creates a pouch from your intestine to hold urine, requiring emptying with a catheter) or a neobladder (where a new bladder is created from a piece of intestine).

Chemotherapy for bladder cancerChemotherapy

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. 

Common intravesical chemotherapy medicines

Common intravesical chemotherapy drugs that are used to treat bladder cancer include:


Mitomycin is a chemotherapy drug that interferes with the DNA of cancer cells to destroy any cancer cells that may remain in the bladder after surgery.  


Gemcitabine12 is a chemotherapy drug that may be used to treat low grade bladder cancer and help prevent it from returning (recurrence). 

Systemic chemotherapy 

Systemic chemotherapy is primarily used for muscle-invasive bladder cancer. The anti-cancer drugs are delivered into the vein to circulate throughout the body. It can be delivered anytime during treatment, including:

  • Before surgery (neoadjuvant) to shrink bladder cancer cells
  • After surgery (adjuvant) to destroy any remaining bladder cancer cells
  • Alongside radiation therapy as part of trimodal treatment (which involves surgery, chemotherapy and radiation)

Typically, a systemic chemotherapy cycle for bladder cancer is given every two to three weeks. Chemotherapy drugs are usually given in combination to increase their overall effectiveness. The duration will depend on your care team’s treatment plan. 

Some of the most common chemotherapy drug combinations used include:

  • Mitomycin and fluorouracil
  • Carboplatin and gemcitabine
  • Carboplatin and etoposide
  • Cisplatin and etoposide
  • Methotrexate, vinblastine, doxorubicin and cisplatin (mvac)

Radiation therapy for bladder cancer Radiation therapy

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 for bladder cancer Immunotherapy for bladder cancer

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. 

Common immunotherapy medicines

Common immunotherapy drugs which are used to treat bladder cancer include:

Bacillus Calmette-Guérin (BCG)

BCG is a vaccine that contains live attenuated bacteria. The BCG bacteria cause the wall of the bladder to become inflamed which stimulates an immune response against the cancerous cells. BCG is suitable for non-muscle invasive bladder cancer and can be provided in combination with TURBT, especially for high-risk cancers. It is delivered directly into the bladder using a catheter and is typically given once a week for six weeks.


Pembrolizumab is a PDL1 type checkpoint inhibitor drug that is used to treat locally advanced or metastatic bladder cancer that has spread outside the bladder. It is usually given by intravenous injection every two to four weeks.

Trimodal therapy for bladder cancerTrimodal therapy

Trimodal therapy offers an alternative treatment option to cystectomy for muscle-invasive cancers which preserves the bladder. It involves a short TURBT surgery followed by chemotherapy and radiation therapy. 

Clinical trials for bladder cancer

Icon offers a wide range of clinical trials providing patients with access to new and evolving treatments. Clinical trials offer hope and opportunity and contribute to breakthroughs in treatment for future cancer patients. 

See current bladder cancer clinical trials delivered by Icon Cancer Centre.

Treatment by stage of bladder cancerTreatment by stage

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:

  • Stage I bladder cancer

    TURBT surgery is typically the first treatment option for bladder cancer. Depending on your cancer’s risk level and growth rate, you may have a second TURBT or a cystectomy. This might be combined with intravesical chemotherapy and immunotherapy. Radiation therapy alongside chemotherapy may also be an option is you cannot undergo surgery.

  • Stage II and Stage III bladder cancer

    A TURBT procedure can determine how far the bladder has spread in the bladder wall. This is typically followed by cystectomy surgery or a trimodal approach. In some cases, you may have a second round of TURBT. Other treatment options include immunotherapy, radiation and chemotherapy.

  • Stage IV bladder cancer

    Systemic chemotherapy is the most common first treatment for Stage IV bladder cancer. This might be followed or combined with radiation therapy and/or immunotherapy. These may also be used alone if you are not well enough for chemotherapy. A cystectomy is another treatment option that can be performed. Its aim is to slow the cancers growth and spread.


For a full list of references, click here.
  1. Cancer Council. (2020). Understanding Bladder Cancer: A guide for people with cancer, their families and friends. Retrieved on 15 November 2021 from
  2. American Cancer Society. (2019). Bladder Cancer Surgery. Retrieved on 15 November 2021 from
  3. American Cancer Society. (2019). Intravesical Therapy for Bladder Cancer. Retrieved on 15 November 2021 from
  4. American Cancer Society. (2019). Chemotherapy for Bladder Cancer. Retrieved on 15 November 2021 from
  5. American Cancer Society. (2019). Radiation Therapy for Bladder Cancer. Retrieved on 16 November 2021 from
  6. National Cancer Institute. (2021). Bladder Cancer Treatment (PDQ®)–Patient Version. Retrieved on 16 November 2021 from
  7. American Cancer Society. (2021). Immunotherapy for Bladder Cancer. Retrieved on 17 November 2021 from
  8. American Cancer Society. (2019). Targeted Therapy Drugs for Bladder Cancer. Retrieved on 17 November 2021 from
  9. American Cancer Society. (2019). Targeted Therapy Drugs for Bladder Cancer. Retrieved on 17 November 2021 from
  10. American Cancer Society. (2021). Treatment of Bladder Cancer, by Stage. Retrieved on 17 November 2021 from
  11. Beat Bladder Cancer. BCG Frequently Asked Questions. Retrieved on 20 November, 2021 from
  12. Bladder intravesical gemcitabine. eviQ. Retrieved on 30 November, 2021 from
  13. Patient information – Bladder cancer – Intravesical mitomycin. EviQ. Retrieved on 30 November, 2021 from ://,bladder%20when%20you%20pass%20urine.
  14. Messing EM, Tangen CM, Lerner SP, et al. Effect of Intravesical Instillation of Gemcitabine vs Saline Immediately Following Resection of Suspected Low-Grade Non–Muscle-Invasive Bladder Cancer on Tumor Recurrence: SWOG S0337 Randomized Clinical Trial. JAMA. 2018;319(18):1880–1888. doi:10.1001/jama.2018.4657
  15. Immunotherapy for bladder cancer. Cancer Council NSW. Retrieved on 30 November 2021 from
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