This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on September 12, 2022.
Treatment for bladder cancer is based on the disease’s stage, as well as on the patient’s health history, age and preferences. This article examines the following standard treatment options, as well as new therapies being studied.
The patient's cancer care team may recommend one of these bladder cancer treatment options, or a combination.
Surgery is typically the first bladder cancer treatment option for early-stage disease because tumors have likely not spread to other areas of the body.
Surgery may be performed for bladder cancers that have recurred or metastasized (spread). For some patients, a bladder-preserving approach may be the recommended option. For others, removal of the entire bladder may reduce the risk of a subsequent cancer. Doctors will discuss types of bladder cancer treatments with the patient to help him or her make an informed decision. Surgical oncology experts are experienced in a variety of procedures, and proactively manage the side effects of bladder cancer surgery.
Depending on the stage of the disease, the care team may recommend one or more of the bladder cancer surgical procedures below.
Transurethral resection of bladder tumor (TURBT): A transurethral resection of bladder tumor, also called a transurethral resection (TUR), is commonly used to both diagnose bladder cancer and treat it. For this procedure, a doctor inserts a thin tube through the urethra and into the bladder. A tool on the end of the tube removes the cancer with a wire loop or burns it with electricity in a process called fulguration.
A transurethral resection with fulguration may be a treatment option if the cancer is diagnosed before stage 4. If the cancer returns, the patient may be able to undergo another TURBT. However, undergoing the procedure too many times may scar and damage the bladder, making it more difficult to hold urine.
Partial cystectomy: If the patient has a low-grade tumor that’s spread to the bladder wall, but is only in one part of the bladder, doctors may recommend a partial cystectomy. Also called a segmental cystectomy, this procedure surgically removes part of the bladder and nearby lymph nodes. After the surgery, the patient is able to urinate normally but may have the urge more often. Very few patients with muscle-invasive bladder cancer are eligible for this surgery.
Radical cystectomy: When the cancer invades the muscle wall, or when superficial cancer covers a large part of the bladder, doctors may recommend a radical cystectomy to completely remove the bladder, as well as nearby lymph nodes, tissues and organs. This procedure also removes the prostate and seminal vesicles in men and the uterus, ovaries, fallopian tubes, cervix and part of the vagina in women.
If the cancer has spread outside the bladder and is unable to be completely removed through surgery, doctors may still recommend surgery to remove the bladder in order to help relieve urinary symptoms the cancer may be causing.
After removing the bladder, surgeons need to make a new way for urine to leave the body—called urinary diversion—and there are a few options, as listed below.
Redirecting urine: The surgeon may redirect the urine into the colon, use a catheter, or create an opening in the abdomen. When an opening is made in the abdomen for urine to go into a pouch worn outside the body, it's called a urostomy. Patients may require a urostomy following a partial or radical cystectomy.
Neobladder: Part of the intestine may be used to make a new bladder—or neobladder—connected to the urethra. Because patient no longer feel urgency to use the bathroom, they must transition to urinating on a schedule.
Some patients receive chemotherapy after surgery, called adjuvant chemotherapy. This helps kill any cancer cells that may still be left in the body. Some may receive chemotherapy first, called neoadjuvant therapy.
Chemotherapy uses medicine to kill cancer cells or stop them from growing or duplicating. Patients with any stage of bladder cancer may receive chemotherapy.
Depending on the type of bladder cancer and stage, patients may receive intravesical chemotherapy or systemic chemotherapy. The main difference is in how the chemotherapy enters the body and which cells it affects.
Intravesical chemotherapy uses a tube inserted through the urethra to deliver medicine directly into the bladder. Also known as regional or local chemotherapy, it mainly affects cancer cells in the affected area, so it causes little to no damage to other cells. It’s usually used after a TURBT or to treat noninvasive bladder cancer.
Systemic chemotherapy is delivered as a pill or injected through an IV. The medicine travels through the bloodstream to reach cancer cells throughout the body. It’s the main treatment for patients whose bladder cancer has spread to other parts of the body (stage 4 cancer). It may also be used to help shrink a tumor before surgery, to help keep the cancer from recurring, or to accompany radiation therapy. It’s commonly used if the bladder cancer is muscle-invasive.
Radiation therapy uses high-energy X-rays or particles to kill cancer cells. It’s not typically used alone to treat bladder cancer. Patients may undergo external beam radiation therapy (which means a machine outside the body directs radiation toward cancer cells) along with other treatments such as surgery or chemotherapy.
Radiation therapy may be used to treat some early-stage bladder cancers, for patients who can’t have surgery or chemotherapy or for patients who underwent surgery that didn’t remove the whole bladder. It may also be recommended to treat stage 4 bladder cancer that has spread to other parts of the body or to reduce or prevent symptoms and improve quality of life.
Immunotherapy, a type of biotherapy or biologic therapy, uses specific substances—either from the body or manufactured in a laboratory—to harness the immune system to fight cancer. These therapies work in different ways.
To treat early-stage bladder cancer, patients may receive a solution of a weakened germ—BCG (bacillus Calmette-Guérin)—inserted directly into the bladder through a catheter. The BCG gets the immune system’s attention, stimulating it to either fight the cancer cells, stop them from growing, or keep them from coming back. BCG is the standard bladder cancer immunotherapy and the most common form of intravesical immunotherapy.
For noninvasive bladder cancer that is either intermediate or high-risk, patients may receive a different immunotherapy delivered directly into the bladder, called induction intravesical immunotherapy. If it works, they may continue this treatment less often for up to several years as maintenance therapy.
Immune checkpoint inhibitors pave the way for the body’s immune system to destroy cancer. They block proteins on cancer cells that are making it harder for the immune system to find and attack them. Doctors may recommend checkpoint inhibitor treatment if:
Targeted therapy finds and attacks certain cancer cell genes, proteins or mechanisms that make it possible for cancer to keep growing. Because these treatments are directed at specific cell types or traits, they don’t typically harm healthy cells as much as chemotherapy or radiation.
Not all bladder tumors have the same cellular traits, so doctors may recommend testing to better understand changes in the individual tumor’s genes and proteins. This helps them identify treatments that may only be an option based on the tumor’s unique biology.
Two targeted therapies are approved for two specific types of cancer patients:
Balversa® (erdafitinib) is for people who have certain locally advanced or metastatic bladder cancer along with specific changes—or mutations—in the tumor. It’s used when chemotherapy hasn’t worked as a treatment.
Padcev™ (enfortumab vedotin-ejfv) is a monoclonal antibody therapy that makes a protein that attacks cancer cells. It delivers a chemotherapy drug directly to the tumor (which makes it an antibody-drug conjugate). It’s used if the patient hasn’t had success with certain immunotherapy or chemotherapy treatments.
Clinical trials research whether new treatments are safe and better than standard treatment. Most of the standard treatments today were first tested in clinical trials. Patients who participate in a clinical trial may get the standard treatment or be among the earliest people to get a new investigational treatment.
Patients who are interested in participating in a clinical trial should talk to the care team about whether they qualify for available studies and whether a clinical trial is the right approach for them.
When considering cancer treatment options, doctors factor in age, other serious health conditions, the cancer’s stage and grade, and the likelihood of a treatment’s success. Patients should discuss treatment goals, as well as the benefits and risks of each treatment option, with their care team. It’s also important for patients to be forthcoming about other medications or supplements they’re taking. Even over-the-counter medications, herbs and supplements may interact with cancer medication and affect treatment.