Treatment for Muscle-Invasive Bladder Cancer

Muscle-invasive bladder cancer means the tumor(s) have grown into the muscle of the bladder. These tumors are stage II (2), stage III (3), or stage IV (4).

Learn more about staging.

Muscle invasive bladder cancer
Adapted from Diagram showing invasive bladder cancer by Cancer Research UK, CC BY-SA 4.0

Ask your health care team about the short- and long-term side effects your treatment may cause. They may have tips on how to cope with those side effects. They can also tell you what symptoms you should let your urology care team know about right away.


Surgery for Stage II (2) or III (3)

Most patients with stage II (2) or stage III (3) bladder cancer will have part or all of their bladder removed. This is called a cystectomy. A partial cystectomy is when only a part of the bladder is removed. A radical cystectomy is a surgery to remove all of the bladder:

  • In men, the surgery removes the entire bladder as well as the prostate and seminal vesicles.
  • In women, the bladder is removed along with the uterus, ovaries, and part of the vagina.
  • Some stage IV (4) patients may be offered surgery.

Your surgeon will reconstruct your urinary tract if your bladder is removed.

Before you have bladder removal and reconstruction:

  • Find a surgeon who performs the surgeries often.
  • Ask questions like: How will your reconstruction work? How long will you be in the hospital? What complications may you experience? How long will it take to recover? How may the surgery affect your sexual functioning?
  • Talk to your doctor about the lifelong follow-up you will need. Your health care team will check your reconstruction and address bladder stones or other health problems.
  • Be aware that you may experience incontinence or urine leakage, no matter what reconstruction you choose.
  • Get support as you learn to use your new bladder. Specialized urology nurses and wound/ostomy nurses can help you in recovery. 
  • Join an in-person or online support group to connect with other bladder cancer patients.


Read about 3 types of urinary reconstruction


Trimodal Therapy (Bladder Preservation) for Stage II (2) or III (3)

A select group of people with Stage II (2) or III (3) bladder cancer may be able to be treated with trimodal therapy. This involves 3 modes of treatment:

  • TURBT (TransUrethral Resection of Bladder Tumor) – Your doctor will insert a scope into your bladder and use a wire loop to remove the tumor.
  • Radiation – Given after surgery, daily, for 4 to 6 weeks. Some patients may receive a radiosensitizer. This is a chemotherapy drug that helps make the radiation more effective.
  • Systemic Chemotherapy – May be given before the TURBT to shrink the tumor.

Trimodal therapy may cause common chemo and radiation side effects. Patients may also have problems with bladder, bowel, and sexual function.


Systemic Treatment for Stage II (2), III (3), and IV (4)

Some people with Stage II (2) and most patients with Stage III (3) and IV (4) will have systemic treatments. Systemic treatments are drugs that travel throughout the body to kill cancer cells.

The systemic treatments used for bladder cancer are:

  • Chemotherapy – Kills cancer cells by killing fast growing cells.
  • Immunotherapy – Helps your body’s immune system to identify, attack, and kill cancer cells. Your care team may use a type of immunotherapy called a checkpoint inhibitor. Learn more about immunotherapy and its side effects.
  • Targeted Therapy – Targets specific changes in cancer cells that help them grow, divide, and spread. Targeted therapy treats the cancer cells with less harm to normal cells.

Chemotherapy is most often given before surgery. This is called neoadjuvant (NEE-oh-AD-joo-vant) chemotherapy. Studies show that neoadjuvant therapy before radical cystectomy improves survival.

Chemotherapy may also be given after surgery. This is called adjuvant chemotherapy. This is often done to try to kill any cancer that may have spread to other parts of the body.

For people with Stage 4 bladder cancer, systemic chemotherapy or immunotherapy is given to:

  • Slow the growth or spread of the cancer
  • Shrink tumors
  • Relieve symptoms
  • Extend life



Jeanne & Mike: Immunotherapy and Bladder Cancer

Jeanne and Mike talk about their journey with immunotherapy and bladder cancer.

Learn More About Immunotherapy

Karl: Immunotherapy and Bladder Cancer

Karl talks about his experience with immunotherapy and bladder cancer.

Learn More About Immunotherapy

Maintenance Therapy

Your health care team may recommend maintenance therapy. The goals of maintenance therapy for muscle-invasive bladder cancer are to delay or to slow down the cancer's growth. These treatments are given to extend a patient's life.

While on maintenance therapy, your care plan will include health monitoring. Health monitoring is when your health care team watches for any changes in your cancer through scans and other tests. If your cancer grows or changes, you may need to stop maintenance therapy.


Clinical Trials

Patients should ask their doctor if they qualify for any clinical trials. These research studies might be looking into new treatments, surgeries, or radiation techniques. Or they might be looking at ways to help cancer survivors. Find clinical trials for bladder cancer patients on the Bladder Cancer Advocacy Network Clinical Trials Dashboard.

Read more about clinical trials

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