Treatment of stage 0 bladder cancer
The main treatment for stage 0 bladder cancer (noninvasive papillary carcinoma and carcinoma in situ) is a surgery called transurethral resection (TUR) with fulguration.
Because stage 0 bladder cancer often comes back after surgery, most people also receive intravesical chemotherapy with mitomycin or gemcitabine at the time of surgery. Some may go on to receive a series of treatments with either intravesical BCG or intravesical chemotherapy.
Some people with stage 0 bladder cancer—those with many tumors or who have carcinoma in situ, a high-grade form of the disease—may have partial or complete cystectomy (surgical removal of the bladder). People with carcinoma in situ who cannot or choose not to have a cystectomy and for whom BCG did not work may receive the immunotherapy drug pembrolizumab.
For more information about these treatments, see Bladder Cancer Treatment.
Treatment of stage I bladder cancer
The main treatment for stage I bladder cancer is a surgery called transurethral resection (TUR) with fulguration. Most people also receive intravesical chemotherapy with mitomycin or gemcitabine at the time of surgery. Some may go on to receive a series of treatments with either intravesical BCG or intravesical chemotherapy.
People with stage I bladder cancer that has recurred (come back) after intravesical therapy may receive partial or complete cystectomy (surgical removal of the bladder).
For information about these treatments, see Bladder Cancer Treatment.
Treatment of stages II and III bladder cancer
The two main treatments for stage II bladder cancer and stage III bladder cancer are radical cystectomy or a combination of radiation therapy and chemotherapy.
Radical cystectomy is surgery to remove the bladder and surrounding tissues and organs. Surgery to make a new way for urine to leave the body (called urinary diversion) will be done. Additional treatments may be given before or after surgery:
- Chemotherapy may be given before surgery to people who are well enough to tolerate it. Giving combination chemotherapy that includes cisplatin before surgery has been shown to help people live longer than surgery alone.
- The immunotherapy drug nivolumab may be given if the cancer has a high risk of coming back after surgery or did not respond to chemotherapy.
People who are unable or choose not to have surgery will receive a combination of radiation therapy and chemotherapy, such as cisplatin and fluorouracil, given at the same time. Giving chemotherapy at the same time as radiation therapy helps the radiation therapy work better.
Partial cystectomy (removal of part of the bladder) is a less common treatment for stages II and III bladder cancer.
To learn more about these treatments, see Bladder Cancer Treatment.
Treatment of stage IV bladder cancer
Treatment of stage IVA bladder cancer may include
- systemic chemotherapy, such as one of the following regimens, given alone:
- methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
- high-dose MVAC
- cisplatin, methotrexate, and vinblastine
- a cisplatin-based chemotherapy regimen followed by surgery to remove the bladder and surrounding tissues and organs (radical cystectomy) and urinary diversion or surgery alone
- radiation therapy and chemotherapy, such as cisplatin and fluorouracil, given at the same time, to help the radiation therapy work better
- urinary diversion, as palliative therapy or to prevent a blockage of urine that could cause kidney damage
- surgery to remove part or all of the bladder (cystectomy) as palliative therapy
Treatment of stage IVB bladder cancer may include
- systemic chemotherapy, such as one of the following regimens:
- gemcitabine with either cisplatin or carboplatin
- methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
- high-dose MVAC
- cisplatin, methotrexate, and vinblastine (CMV)
- an immunotherapy drug, such as avelumab, nivolumab, or pembrolizumab
- radiation therapy as palliative therapy
- urinary diversion, as palliative therapy or to prevent a blockage of urine that could damage the kidneys
- surgery to remove part or all of the bladder (cystectomy) as palliative therapy
Palliative therapy is treatment meant to relieve symptoms and improve the quality of life of people who have a serious or life-threatening disease, such as cancer. Many of the same treatments for cancer, such as surgery and radiation therapy, can also be used for palliative therapy to help a person feel more comfortable. Learn more about Palliative Care in Cancer.
To learn more about these treatments, see Bladder Cancer Treatment.
Treatment of recurrent bladder cancer
Treatment of bladder cancer that has recurred (come back) depends on previous treatment and where the cancer has come back. Treatment may include
- systemic chemotherapy, such one of the following regimens, given alone:
- gemcitabine with either cisplatin or carboplatin
- methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
- high-dose MVAC
- cisplatin, methotrexate, and vinblastine
- an immunotherapy drug, such as avelumab, nivolumab, or pembrolizumab
- a targeted therapy drug, such as enfortumab vedotin, erdafitinib, or ramucirumab
- surgery for non-muscle-invasive or localized tumors, which may be followed by immunotherapy and chemotherapy
- radiation therapy as palliative therapy
Palliative therapy is treatment meant to relieve symptoms and improve the quality of life of people who have a serious or life-threatening disease, such as cancer. Many of the same treatments for cancer, such as radiation therapy, can also be used for palliative therapy to help a person feel more comfortable. Learn more about Palliative Care in Cancer.
To learn more about these treatments see, Bladder Cancer Treatment.
