Treatment: invasive and advanced bladder cancer

The type of treatment you’re offered will depend on whether the cancer is still confined to the bladder or has spread elsewhere.  It also depends on 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.

Treatment to cure the cancer

Cancer that invades the muscle wall of the bladder but has not spread beyond the fat surrounding the bladder can be treated with the aim of curing the cancer or controlling it for a long time.

Surgery or radiotherapy are the main treatments used.

Surgery usually involves removing the bladder and diverting urine drainage to a bag on the abdominal wall or fashioning a new bladder out of a length of bowel.  This is large and complex surgery and we refer these patients to Southmead Hospital in Bristol for this treatment. 

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.

Chemotherapy given to shrink a bladder tumour before surgery is called neo-adjuvant chemotherapy. The aim is to reduce the risk of your cancer coming back later on.  We routinely use this approach as it has been shown to improve patient survival.

Sometimes chemotherapy is given at the same time as radiotherapy (chemoradiation). This helps make the radiotherapy more effective.

Treatment to control the cancer and relieve symptoms

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.