About your treatment

Treatment for bladder cancer depends on whether the cancer is:

  • Non-muscle-invasive

    The cancer cells are only in the inner lining of the bladder. They have not spread into the muscle layer.

  • Muscle-invasive

    The cancer has spread into or through the muscle layer of the bladder.

  • Locally advanced

    The cancer has spread outside the bladder into nearby tissues, such as the prostate, vagina, ovaries, womb or back passage (rectum). It may also be in a lymph node in the pelvis, near to the bladder.

  • Advanced

    The cancer has spread from the bladder to other parts of the body, such as the liver, lungs or bones, or to lymph nodes further from the bladder.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.

You may have some treatments as part of a clinical trial.

Treating non-muscle-invasive bladder cancer

Treatment for non-muscle-invasive bladder cancer usually depends on what risk level the tumour is. This means the risk of the cancer spreading into the muscle of the bladder and the risk of it coming back. Your doctor looks at different things to decide on the risk level of the cancer. This includes:

  • the size of the tumour
  • how far the tumour has grown into the bladder (T stage)
  • how many tumours there are
  • the grade of the tumour
  • if you have already had non-muscle-invasive bladder cancer in the last year.

Non-muscle-invasive bladder cancer can be grouped into three categories:

  • low-risk
  • intermediate-risk
  • high-risk.

Your doctor and specialist nurse can give you more information about risk groups.

Surgery to remove non-muscle-invasive bladder cancer

Surgery is the main treatment for non-muscle-invasive bladder cancer. Most people have an operation called a transurethral resection of the bladder tumour (TURBT).

You usually have chemotherapy into the bladder immediately after surgery. You may be in hospital for 1 to 3 days.

Further treatment for non-muscle-invasive bladder cancer

If you have a low-risk tumour, you will not need any further treatment after surgery.

If you have an intermediate or high-risk tumour, you usually need further treatment. Treatment is usually with chemotherapy or an immunotherapy drug called BCG. Both are given directly into the bladder. High-risk bladder cancer is usually treated with BCG.

Occasionally, your specialist may ask you to think about having surgery to remove the bladder. This may happen if you have a very high-risk cancer or a cancer that comes back after BCG treatment. The operation is called a cystectomy.

Other treatments for non-muscle-invasive bladder cancer

Other treatments are being tested for non-muscle-invasive bladder cancer. You may be offered these as part of a clinical trial. These treatments may only be available at some hospitals. If your urologist thinks a clinical trial may be helpful for you, they can refer you to the hospital doing the trial.

Treatments include:

  • Heated intravesical chemotherapy

    Some trials are trying to find out if using heat makes chemotherapy given into the bladder work better. A thin tube with a rounded end (a probe) applies microwave heat to the bladder lining while chemotherapy is given into the bladder. Or a machine is used to heat the chemotherapy before it goes into the bladder.

  • Electromotive intravesical chemotherapy

    For this treatment a small electrical current is given into the bladder at the same time as the chemotherapy. This helps the cancer cells absorb more of the chemotherapy drug. This treatment is also called electromotive drug administration (EMDA).

    Your nurse puts a catheter into your bladder. This catheter contains a wire which is attached to a small machine. Your doctor or nurse usually puts 2 electrode pads on the skin of your tummy. These are also attached to the small machine. The chemotherapy is put into your bladder through the catheter. After this, they switch on the machine and it delivers the electrical current.

    Sometimes, this treatment is combined with having BCG into your bladder.

  • Tumour ablation

    This treatment uses a laser (infra-red light) during a cystoscopy to burn any areas of cancer away.

    Sometimes, blue-light cystoscopy (PDD) is used during tumour ablation. This treatment is only available for certain non-muscle-invasive bladder tumours. Your doctor will refer you if they think this treatment may work for you.

  • Immunotherapy

    Immunotherapy drugs encourage the body’s immune system to fight cancer cells.

Coping with bladder problems during and after treatment

During your treatment, you may have symptoms such as:

  • passing urine (peeing) more often
  • rushing to the toilet to pass urine
  • a burning sensation when you pass urine.

For most people, these symptoms last for a few days after treatment. Your urologist or specialist nurse can talk to you about things you can do to help. They will give you medication if needed.

Some people can have problems controlling their bladder during and for some time after treatment. This is called urinary incontinence. This can be a rare side effect of having lots of cystoscopies.

It is important that you talk to your doctor or nurse if this is a problem for you. They may refer you to a continence adviser or specialist physiotherapist who can give you advice. The Bladder and Bowel Community can also help.

We have more tips for coping with bladder and bowel problems.

Giving up smoking

If you smoke, this can make bladder symptoms worse. Stopping smoking may decrease the risk of non-muscle-invasive bladder cancer coming back.

We have more information on giving up smoking.

After treatment for non-muscle-invasive cancer

Follow up after treatment

After your treatment, you will have regular check-ups with your cancer doctor or nurse. The most important test for follow-up is a cystoscopy. How often you have a cystoscopy depends on the risk of the cancer coming back. High-risk and intermediate-risk tumours need to be monitored more often than low-risk tumours.

You may also have your urine checked for cancer cells. At first, follow-up will usually be every 3 to 6 months.

It is important to tell your doctor straight away if you notice any new symptoms, or symptoms that come back, between your appointments. Your doctor will check what may be causing your symptoms.

Many people find they get anxious before their follow-up appointments. This is natural. It may help to get support from a partner, family member or friend. If you feel you have no one to talk to, you can call our cancer support specialists on 0808 808 00 00.

If non-muscle-invasive bladder cancer comes back

It is not uncommon for bladder cancer to come back in the lining of the bladder. Non-muscle-invasive bladder cancer that comes back can usually be cured or controlled for a long time. It can usually be treated with surgery to remove it again. This is called transurethral resection of a bladder tumour (TURBT). Some people may also have chemotherapy or BCG into the bladder.

In some situations, a urologist may advise having an operation to remove the bladder (cystectomy). This may be when:

  • the cancer keeps coming back and further treatments are not working
  • the cancer starts to grow into the muscle layer of the bladder (this is called muscle-invasive bladder cancer).

A cystectomy aims to treat the cancer before it goes into or spreads further in the muscle of the bladder.

It can be hard to hear you need to have your bladder removed. Urologists will always consider the different treatments available to try to keep your bladder. With help from family members, friends, health professionals and support organisations, people usually manage to cope well with a cystectomy.

We have more information about having a cystectomy.

Treating muscle-invasive and locally advanced bladder cancer

People with muscle-invasive and some people with locally advanced bladder cancer usually have treatment to cure the cancer. If a cure is not possible, treatment can be given to control the cancer to help you live longer and reduce symptoms.

Most people have either surgery or radiotherapy as their main treatment. Your doctor may ask you to choose between these treatments as they can both be effective. Some people may also be offered chemotherapy.

Your cancer doctor or nurse will talk to you about the different treatment options and things to think about when making treatment decisions. You can then decide together what treatment is best for you.

Before you make any treatment decisions, make sure you understand:

  • what each treatment involves
  • how it may affect your life
  • its advantages and disadvantages.

You may find it helpful to look at our information comparing surgery and radiotherapy for muscle-invasive and locally advanced bladder cancer.

Some treatments can cause infertility in men and women. If you are worried about your fertility, talk to your doctor before your treatment starts.

Surgery to remove the bladder

Surgery for muscle-invasive and locally advanced bladder cancer usually involves removing the whole bladder (cystectomy). It also involves making a new way for you to pass urine (urinary diversion).

We have more information about having a cystectomy and about different types of urinary diversion.

Radical radiotherapy for bladder cancer

Radiotherapy uses high-energy rays to destroy cancer cells. Radical radiotherapy means using high doses of this treatment to cure bladder cancer.

We have more information about radical radiotherapy for bladder cancer.

Having chemotherapy with your main treatment

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For muscle-invasive and locally advanced bladder cancer, you may have chemotherapy:

  • before surgery or radiotherapy, to shrink the cancer and reduce the risk of it coming back. This is called neo-adjuvant chemotherapy.
  • with radiotherapy, to make treatment work better. This is called chemoradiation.
  • after surgery, if there is a high risk of the cancer coming back (adjuvant chemotherapy).

After treatment for muscle-invasive or locally advanced bladder cancer

Follow up after treatment

After your treatment for muscle-invasive or locally advanced bladder cancer, you will have regular check-ups with your cancer doctor or nurse. You will also have scans to check for any sign of the cancer coming back.

If you have had a urostomy, a continent urinary diversion or a bladder reconstruction, you will have regular scans to check your kidneys are working well. You will also have blood tests.

If your urethra was not removed during surgery, there is a small risk that the cancer could come back there. You will have tests every year to check the urethra (urethroscopies). This usually continues for 5 years.

If you have had radiotherapy, you will have regular cystoscopies. These will be every 3 months at first, but you will have fewer cystoscopies over time. You will have them for at least 5 years after treatment finishes.

Tell your doctor straight away if you notice any new symptoms or symptoms that come back between your appointments.

Many people find they get anxious before their follow-up appointments. This is natural. It may help to get support from a partner, family member or friend. If you feel you have no one to talk to, you can call our cancer support specialists on 0808 808 00 00.

If muscle-invasive or locally advanced bladder cancer comes back

If the cancer comes back, you can usually have more treatment. The type of treatment you have will depend on where it has come back and the treatment you had before. Your doctor will talk to you about the possible options.

If the cancer comes back after radiotherapy, some people may be able to have surgery to remove their bladder. If you have had your bladder removed, other treatments can be used. Your doctor will talk to you about the treatment that is best for your situation and ask about your preferences.

Treating advanced bladder cancer

Advanced bladder cancer means cancer that has spread from the bladder to other parts of the body. Sometimes this is called metastatic bladder cancer.

Unfortunately it is not possible to cure advanced bladder cancer. Treatment aims to:

  • control the cancer and help you live longer
  • reduce your symptoms and improve quality of life
  • shrink the size of the tumour or stop it from growing for a while.

The symptoms of advanced bladder cancer can often be relieved by different treatments to control the cancer. Radiotherapy can treat symptoms such as pain. Sometimes this works quickly, and you may notice an improvement within a few days. But sometimes it may take a few weeks before you feel the benefit.

There are also other ways to relieve and control symptoms. We have more information about how symptoms such as pain, breathlessness, feeling sick or tiredness can be relieved.

Always let your doctor or specialist nurse know if you have new symptoms, or if your symptoms get worse.

You may have one or more of the following treatments:

  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have a combination of chemotherapy drugs or one drug on its own to treat advanced bladder cancer.

  • Immunotherapy

    Immunotherapy drugs encourage the immune system to recognise and help destroy cancer cells. You may have drugs called atezolizumab or pembrolizumab if you cannot have chemotherapy or if chemotherapy has stopped working.

  • Radiotherapy

    Radiotherapy uses high-energy rays to destroy cancer cells. You may have radiotherapy to treat bladder symptoms, such as pain or bleeding. It may be given as 3 treatments over a week or sometimes as 1 single treatment. Each treatment takes around 10 to 15 minutes.

    Radiotherapy can also be used to treat pain if the cancer has spread to the bones. You may only need 1 treatment or up to 5 treatments.

  • Bisphosphonates

    You may have drugs called bisphosphonates to help control pain if bladder cancer has spread to the bones.

  • Ureteric stent

    Sometimes, bladder cancer can block the tube called the ureter between the kidney and the bladder. Your doctor may suggest an operation to put a tube (stent) in to open the ureter. This is called a ureteric stent.

  • Nephrostomy

    If it is not possible to put in a ureteric stent, you may have a tube put into your kidney (or kidneys). This is called a nephrostomy. The tube is connected to a bag, which is worn under your clothing.

Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will consider what is important to you and how treatment may affect you. This will help you both decide on the best course of treatment.

Sometimes the side effects of a treatment outweigh the benefits of having it. In this case, you may want to think about whether to continue that treatment. You will still be offered treatment and support to manage any symptoms caused by the cancer.

Your cancer doctor or GP may refer you to a palliative care team. This is an expert team that helps manage symptoms, such as pain or nausea. There are palliative care teams based in hospitals, hospices or in the community.

More information about coping with advanced cancer

Finding out you have advanced cancer can be difficult to cope with. You may feel shocked and find it hard to understand. Or you may have questions about what to expect. Your doctor and specialist nurse are there to help. We have more information about coping with advanced cancer that you may find helpful.

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