Treatment overview for invasive and advanced bladder cancer
The type of treatment you’re offered will depend on the stage of the cancer, its size and your general health. Treatment may be given to cure the cancer, or if a cure isn’t possible, it can be given with the aim of controlling the cancer and relieving your symptoms.
This information is about treatment for invasive and advanced bladder cancer. We also have information about treatment for early bladder cancer.
Your doctor will be able to discuss with you what stage of bladder cancer you have.
Treatment to cure the cancerBack to top
People with bladder cancer at stage 2 or stage 3 are usually given treatment with the aim of curing the cancer or controlling it for a long time.
Surgery or radiotherapy are the main treatments that are used. Surgery usually involves removing the bladder, so you will pass urine differently from before. Radiotherapy uses high-energy rays to destroy the cancer cells. It means that you will keep your bladder. Radiotherapy causes side effects, and some people may have long-term side effects.
Your specialist can suggest the treatment that’s most suitable for you. For example, if your general health is good, the tumour appears confined around the bladder and there aren’t any signs of spread elsewhere (metastases), surgery may be advised. If you have a medical condition that makes surgery more risky, radiotherapy may be recommended. If you have a larger tumour, then surgery may sometimes be recommended.
Some people are offered the choice of having either surgery or radiotherapy. Sometimes both treatments have the same chance of curing the cancer, but each has its own specific benefits and disadvantages (see below). Your specialist will talk this over with you so that you have enough information to decide which treatment is right for you. You may also be offered chemotherapy (anti-cancer drugs), which can be given before, during or after your main treatment.
Chemotherapy given to shrink the tumour before surgery or radiotherapy is called neo-adjuvant chemotherapy. The aim is to reduce the risk of your cancer coming back later on.
Sometimes chemotherapy is given at the same time as radiotherapy (chemoradiation). This helps make the radiotherapy more effective.
Chemotherapy is sometimes given after surgery to reduce the risk of the cancer coming back. This is called adjuvant chemotherapy and is generally given as part of a clinical trial because it’s not yet clear how helpful it is.
Treatment to control the cancer and relieve symptomsBack to top
If your cancer is advanced, you’ll usually be given treatments aimed at controlling tumour growth and improving your symptoms. Treatment given to relieve symptoms is called palliative treatment.
Chemotherapy can be effective at controlling the cancer in some people, but it can also cause side effects. Your doctor will check that you’re fit enough to cope with these when deciding if this treatment is likely to be right for you.
Radiotherapy can also be helpful. It is used to treat symptoms, such as bleeding from a tumour in the bladder, or to relieve pain if cancer has spread to the bones.
Planning your treatmentBack to top
In most hospitals, a team of specialists will meet to discuss and agree on a plan of treatment they feel is best for you. This multidisciplinary team (MDT) may include:
- urologists - surgeons who specialise in treating bladder cancer
- clinical oncologists - doctors who treat cancer with radiotherapy and chemotherapy
- medical oncologists - doctors who treat cancer with chemotherapy
- palliative care consultants - doctors who specialise in symptom control
- pathologists - doctors who specialise in how disease affects the body
- radiologists - doctors who analyse x-rays and scans
- specialist nurses - nurses who give information and support to people with bladder cancer.
Other healthcare professionals are also available to help you if necessary, such as:
- occupational therapists
- psychologists or counsellors.
Your doctors will talk to you about the best treatment for your particular situation. If you have any questions about your treatment, don’t be afraid to ask your doctor or the nurse looking after you. It often helps to make a list of the questions you want to ask and to take a close friend or relative with you to help you remember what is discussed.
Your doctors may offer you a choice of treatments if more than one treatment is equally effective for your type and stage of cancer. If this is the case, some people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the possible side effects so that you can decide what the right treatment is for you.
Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are known as clinical trials. You may also be offered the choice of participating in a clinical trial.
For more on planning your treatment, you may find it helpful to read our information on:
- giving your permission (consent) for treatment to begin
- making decisions about cancer treatment
- seeking a second opinion.
The benefits and disadvantages of treatmentBack to top
You may feel worried about having cancer treatment because of the potential side effects that can occur. If you’re offered a choice of surgery or radiotherapy to try to cure the cancer, you’ll need to weigh up the possible benefits and disadvantages of each treatment to help you to decide.
Before deciding whether to go ahead with a treatment, you may want to know how likely it is to be effective. If a treatment is aimed at curing the cancer, you may want to know what the chances are of the cancer coming back after treatment. Your doctor can talk this through with you.
If the cancer is advanced and has spread to other parts of the body, you may be offered chemotherapy to control it. This may control the cancer for a time, improving your symptoms and quality of life. If you are having chemotherapy, you’ll be checked closely for signs that it’s working and to see if there are side effects. Some tumours are not sufficiently sensitive to chemotherapy, and in this situation, the treatment can be stopped.
If you choose not to have treatment to control the cancer, there may be other treatments that can help to relieve the symptoms caused by cancer. Treatment given in this situation is known as supportive or palliative care.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss things in detail with your doctors.
Benefits and disadvantages of surgeryBack to top
- Doesn't involve radiation, so avoids the side effects of radiotherapy (eg diarrhoea and bladder irritation)
- No need for follow-up cystoscopies
- 7-14 days in hospital for the operation and up to 3 months recovery time
- You'll need a general anaesthetic
- You'll need to wear a urostomy bag, learn to self-cathertise or learn to pass urine again
- Tiredness after the operation
- High risk of impotence in men and changes in sexual sensation in women
- Risk of death related to the surgery is about 2 in 100 but may be higher in older people and people with additional health problems.
Benefits and disadvantages of radiotherapyBack to top
- Doesn't involve an operation
- No anaesthetic needed
- After treatment it is possible to pass urine normally
- You'll need to travel to the hospital each weekday for 4-7 weeks for treatment
- Tiredness during and after treatment (may last for some months)
- Common side effects during treatment include bladder irritation (passing urine more often and urgently) and diarrhoea
- A minority of people develop long-term changes to their bowel habit (eg passing stools more often or urgently than before)
- Some men have weaker erections or are unable to have an erection after radiotherapy.