Bladder Cancer Treatments

In some cases, your oncologist (a physician who specializes in cancer) may recommend some type of urologic surgery. Our surgeons have years of experience performing complex bladder cancer surgery and achieving excellent results.

Transurethral Resection of Bladder Tumor (TURBT)

Urologists often use a transurethral resection of bladder tumor (TURBT) to find out if someone has bladder cancer. We can then determine whether the cancer has spread into the muscle. It is also the most common treatment for early-stage bladder cancers. Another term for TURBT is transurethral resection (TUR).

Cystectomy

When bladder cancer is invasive or intravesical treatments do not work, your care team may surgically remove all or part of your bladder. This operation is known as cystectomy. It’s likely that you would receive chemotherapy before having a cystectomy.

Robotic Radical Cystectomy

Our bladder cancer treatment group is at the forefront of robotic radical cystectomy in New England.

Partial Cystectomy

If the cancer has invaded the muscle layer of the bladder wall but is not very large and is only in one place, the surgeon may be able to remove it, along with part of the bladder wall, without taking out the whole bladder. The surgeon then closes the hole in the bladder wall with stitches. The surgeon also removes nearby lymph nodes and tests those to see if the cancer has spread.

Only a small portion of people with invasive bladder cancer can have this surgery. The main advantage is that you keep your bladder and won’t need reconstructive surgery. But the remaining bladder may not hold as much urine, and the bladder cancer can come back in another part of the bladder wall. At BIDMC, we often perform this surgery robotically.

Radical Cystectomy

If the cancer is larger or is in more than one part of the bladder, you will need a radical cystectomy. During this procedure, your surgeon removes the entire bladder and nearby lymph nodes. Robotic extended lymph node dissection (removal) improves the chance for longer survival in those with bladder cancer that has spread to the muscle.

In men, the surgeon also removes the prostate and seminal vesicles (small glands and structures that produce fluid that makes up semen). In women, the surgeon removes some of the female reproductive organs, including the ovaries, fallopian tubes, uterus, cervix and a small part of the vagina.

In the past, a surgeon used traditional open surgery to perform a cystectomy through one large incision in the abdomen. However, the vast majority of patients having this surgery at BIDMC are eligible for minimally invasive, robotic surgery.

If you have advanced bladder cancer, you may be eligible for robotic radical cystectomy with urinary diversion. Surgeons create a neobladder (new bladder) by taking a piece of the small intestine and forming a new reservoir for urine. The result is that you can urinate naturally rather than needing an ileostomy bag on the outside of your body.

The neobladder is a surgical innovation that suddenly improved the quality of life for many people with bladder cancer who need their bladder removed. BIDMC is one of the only academic medical centers in New England offering this procedure with the assistance of a surgical robot.

The benefits for you include: 

• Faster healing
• Less blood loss during the procedure
• Lower use of narcotic painkillers

If chemotherapy is part of your treatment plan for bladder cancer, you may receive one of two types.

Intravesical Chemotherapy

The oncologist inserts the chemotherapy (cancer-killing drugs) directly into the bladder. If you have bladder cancer only in the lining of your bladder, your oncologist may recommend intravesical chemotherapy. It may help reduce the risk of your bladder cancer coming back or progressing to a higher stage.

Systemic Chemotherapy

You receive this type in pill form or as an injection into your vein or muscle. This allows the drugs to go into the bloodstream and travel throughout the body. It can affect cancer cells anywhere in the body. Systemic chemotherapy can increase the chance for a cure in a person who’s having surgery to remove their bladder, or as the main treatment when surgery isn’t an option.

Your oncologist can use systemic chemotherapy:

• Before surgery to try to shrink a tumor so it's easier to remove and to help lower the chance the cancer will come back.
• After surgery (or sometimes after radiation therapy) to kill cancer cells that may remain after other treatments. This can lower the chance that the cancer will come back later.
• While getting radiation therapy to help the radiation work better.
• As the main treatment for bladder cancers that have spread to other parts of the body.

Radiation therapy uses high-energy radiation to kill cancer cells. The oncologist can use radiation therapy:

• As part of the treatment for some early-stage bladder cancers after surgery that doesn’t remove the whole bladder (such as TURBT)
• As the main treatment for people with cancer in an early stage
• To try to avoid cystectomy
• As part of treatment for advanced bladder cancer
• To help prevent or treat symptoms caused by advanced bladder cancer

Oncologists often give radiation therapy at the same time as chemotherapy to help the radiation be more effective.

Immunotherapy uses medicine to help your immune system recognize and destroy cancer cells. Immunotherapy triggers the body’s immune system to fight cancer cells — either in the bladder or throughout the body.