Bladder Cancer Treatment
Treatment recommendations for bladder cancer will depend on the cancer type, the stage and grade and how far the cancer has advanced.
Many times, treatment plans will include a combination of surgery, medication (such as chemotherapy or immunotherapy) and radiation therapy.
We are actively involved in clinical and laboratory research to bring the latest interventions to our patients, improve outcomes and promote scientific advancement.
Surgical Treatment for Bladder Cancer
Surgical options range from less-invasive outpatient procedures to complete bladder removal and reconstruction.
Robotic Surgery
Robotic surgery is the preferred surgical procedure for select bladder cancer patients at Weill Cornell Medicine and NewYork-Presbyterian Hospital. Our institution was among the first to perform robotic surgery and now has over a decade’s worth of experience treating patients with this technique.
The minimally invasive procedure is performed using the da Vinci® system, a robotic surgery device approved by the Food and Drug Administration. Robotic surgery is done under 12X magnification and allows surgeons to much better appreciate tissue planes and visualize critical nerve structure. Robotic techniques can significantly diminish complications following bladder cancer surgery and often result in faster recovery times and shorter hospital stays.
Advanced robotic techniques support our physicians’ commitment to maintaining all aspects of quality of life, including sexual function, while optimizing cure rates for patients with bladder cancer.
Your doctor may recommend one or more of the following surgical procedures:
Bladder Resection (Tumor Removal)
In most early-stage bladder cancers, a small tumor has developed on the superficial layer of the bladder wall. In these cases, a tumor removal (resection) may be necessary.
- Transurethral Resection of Bladder Tumor (TURBT): Most non-invasive bladder cancers can be treated with TURBT, a scraping of the bladder. This surgery is typically performed without an incision using a cystoscope. At Weill Cornell, we utilize a “blue light” cystoscopy technique in which a chemical is administered inside the bladder prior to TURBT, making the tumor cells fluoresce so that they can be removed by the surgeon. The cystoscope is moved through the urethra to the bladder where it is used to remove tumor tissue. TURBT is often performed as an outpatient procedure, meaning patients go home the same day.
Bladder Removal (Cystectomy)
When a tumor grows beyond the layers of the bladder wall and invades the muscle, all or part of the bladder must be removed. This type of procedure is called a cystectomy. Our team at Weill Cornell is dedicated to always attempt a bladder-sparing approach when feasible, and we have robust experience with robot-assisted bladder-sparing techniques and radical cystectomies. We also have expertise in treating patients with a history of pelvic irradiation – a population in which cystectomy is associated with an overall higher risk of complications.
- Partial Cystectomy: If the cancer has invaded the bladder wall but the tumor is small and confined to one region, just the affected section of the bladder may need to be removed. This is called a partial cystectomy. A partial cystectomy allows for preservation of non-cancerous bladder tissue.
- Radical Cystectomy: If the cancer is large in size or has invaded more than one section of the bladder, the entire bladder may need to be removed. Depending on how far the cancer has spread, nearby lymph nodes or other structures may also need to be removed. In men, this can include the prostate. In women, this can include the ovaries, fallopian tubes, uterus and a portion of the vagina.
Kidney or Ureter Removal (Nephrouretectomy or Partial Ureterectomy)
In Upper Tract Urothelial Cancer, or UTUC, which is a form of urothelial cancer found in the renal pelvis or ureter, the surgical treatment involves removing the cancerous parts of the kidney and ureters. Cancer in the renal pelvis is relatively rare, and care plans for this cancer type are developed jointly by our experts in bladder and kidney cancer treatment.
Bladder Reconstruction
Based on the type of surgery needed to treat your bladder cancer, you may need your bladder reconstructedto restore bladder function. Drawing from a toolbox of sophisticated procedures and advanced robotic technology, our surgeons are able to create a functionally normal lower urinary tract — one that will store and empty urine, maintain continence and preserve kidney, nerve and sexual function. Bladder substitution and reconstruction procedures offered at Weill Cornell Medicine include:
- Neobladder Reconstruction: During this procedure, a section of your bowel is used to create a new bladder inside your pelvis. This new bladder is connected to your urethra, allowing you to urinate normally. This procedure is sometimes referred to as orthotopic neobladder reconstruction.
- Continent Urinary Reservoir: During this procedure, a urine reservoir is created from a portion of your intestine. This reservoir is connected to a stoma (artificial opening) in your lower abdomen. Urine is emptied manually by inserting a tube into the stoma. This procedure is also referred to as the Indiana Pouch.
- Urostomy: A urostomy/ileal conduit creates a new route for urine flow. During this procedure, urine is re-routed to an artificial opening in the belly called a stoma. A pouch is connected to the stoma to collect and store urine until it can be drained. This new pathway allows urine to exit the body efficiently and maintains normal kidney function.
Medication Therapy
Medication therapy is often used in conjunction before or after surgery for bladder cancer. Treatments for bladder cancer include chemotherapy, immunotherapy and molecular targeted therapy.
Chemotherapy
Chemotherapy involves the use of a medicine to either treat cancer by killing cancerous cells or reduce cancer symptoms. In patients with muscle-invasive bladder cancer, it can be delivered before a planned cystectomy (neoadjuvant) or after a planned cystectomy (adjuvant) in order to prevent spread of disease to other parts of the body. Chemotherapy is administered in cycles and can be given in two different ways: intravesical and systemically.
- Intravesical chemotherapy: This procedureinvolves inserting the drug directly into the bladder. This type of chemotherapy is typically used when bladder cancer exists only in the bladder’s lining (superficial bladder cancer). It is standard of care that all patients receive one dose of intravesical chemotherapy after any bladder biopsy in order to diminish the risk of recurrences.
- Systemic chemotherapy: When chemotherapy is given in pill (oral) form or injected into a vein (IV) or muscle (IM), it is called systemic chemotherapy. Systemic chemotherapy is often used for bladder cancers that have spread to other parts of the body. This type of chemotherapy can be given either before or after surgery.
Immunotherapy
Immunotherapy can stimulate the body's defenses to attack and kill cancer cells. Patients often receive immunotherapy as well as surgery or chemotherapy. Immunotherapy is not appropriate for every patient, as everyone responds differently. Optimizing response to immunotherapy treatment is an area of ongoing research at Weill Cornell Medicine. The two most effective types of immunotherapy for bladder cancer are:
- Checkpoint Inhibitor Therapy: Cancer cells thrive because they hide and evade detection from the body’s immune system. To help the immune system better recognize and attack bladder cancer cells, intravenous drugs called immune checkpoint inhibitors are frequently used. This approach to treatment is very promising for bladder cancer.
- Bacillus Calmette-Guérin (BCG). This immunotherapy type is a vaccine administered directly into the bladder. It works by stimulating the immune system so that it attacks cancer cells in the bladder. The BCG solution is placed inside the bladder once a week for six weeks, followed by a period of maintenance therapy. BCG is effective in approximately 70 percent of patients with superficial bladder cancer.
Molecular Targeted Therapy
Molecular targeted cancer therapy, sometimes referred to as targeted therapy, works by using drugs to target specific molecules that contribute to cancer growth and progression. As opposed to many forms of chemotherapy, which work by killing rapidly dividing cancer cells, targeted therapies work at a deeper, more targeted level, based on the makeup of an individual’s cancer cells. This treatment approach is sometimes referred to as precision medicine, utilizing information from a person’s genes and proteins to interfere with specific molecules and processes involved in cancer growth. At Weill Cornell Medicine, we routinely perform comprehensive genetic characterization of a patient’s tumor, which can inform next steps and bladder cancer treatment options if actionable molecular targets are identified. Additionally, we are able to offer the latest molecular targeted therapies to patients in need of this type of bladder cancer treatment.
Radiation Therapy
Radiation therapy is a type of cancer treatment that delivers radiation into the body to kill cancer cells. It may be used as the main treatment, or in combination with other treatments for bladder cancer. It is often given together with chemotherapy, which can act as a radiosensitizer by making cancer cells more vulnerable to radiation therapy. Radiation therapy may be an option for people who cannot have surgery or receive chemotherapy. It is also a treatment for bladder cancer that has spread to other parts of the body.
Combination Therapy
Many patients — especially those with more advanced bladder cancers — will benefit most from a combination of surgical, medical oncology and radiation therapies. A combination of multiple treatment options can help to fight cancer and reduce cancer symptoms. The multidisciplinary team of experts at Weill Cornell Medicine and NewYork-Presbyterian, in conjunction with our patient navigators, are able to offer integrated care and seamless access to these treatments.
Clinical Trials
Clinical trials are research studies that test the effectiveness of new treatments. These studies allow patients to try new medications being tested for bladder cancer. Search our bladder cancer clinical trials, and talk to your doctor if you are interested in participating or for more information. Your doctor can help you decide which clinical trial is the best for you.