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Treatment for Muscle-Invasive Bladder Cancer

Muscle-invasive bladder cancer means the tumor(s) have grown into the muscle of the bladder and may have spread outside the bladder. These tumors are stage II (2), stage III (3) or stage IV (4). For more information about staging, visit our Diagnosis & Staging page.

Ask your health care team about the short- and long-term side effects your treatment may cause and how to cope with those side effects. You will also want to know 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 their bladder removed. The surgery is called a radical cystectomy.

  • In men, the surgery involves removing 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.

If you have your bladder removed, your surgeon will reconstruct your urinary tract at the same time as the bladder removal surgery.

Before you have bladder removal and reconstruction:

  • Find a skilled surgeon who performs bladder removal and the kind of urinary reconstruction you are getting many times a month.
  • Be sure to have all of your questions answered about how your urinary reconstruction will work.
  • Fully review with your doctor how long you will be in the hospital, the complications you may experience, how long your recovery will be, and how the surgery may affect your sexual functioning.
  • Talk to your doctor about the lifelong follow-up you will need to check your reconstruction and to prevent or 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 before you get your surgery and as you learn how to use your bladder substitute. This can come from specialized urology nurses, wound/ostomy nurses, and in-person or on-line support groups.

For information on the three different kinds of urinary reconstruction, see our bladder substitute section.

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 (three modes of) Therapy. The three modes are:

  1. A TURBT (short for TransUrethral Resection of Bladder Tumor). During the procedure, your doctor will insert a scope into your bladder and use a wire loop to remove the tumor.

©2019 Terese Winslow

  1. Radiation, given after surgery, daily, for 4 to 6 weeks. Some patients may also receive a radiosensitizer—a chemotherapy drug that helps make the radiation more effective.
  2. Systemic Chemotherapy, which may be given before the TURB-T to shrink the tumor.

Trimodal therapy often has side effects. These can include common side effects of chemo and radiation, as well as 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—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. For bladder cancer, a type of immunotherapy called a checkpoint inhibitor is typically used. Visit our immunotherapy webpage to learn more about this treatment and its side effects.

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 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

Clinical Trials

Patients with muscle invasive bladder cancer, should ask their doctor if there are any clinical trials they should consider as treatment options. These research studies might be investigating new drugs, new drug combinations, or new surgical or radiation techniques. Or, they might be looking at ways to help cancer survivors.