Treatment of bladder cancer

Non-muscle-invasive bladder cancer, also called superficial bladder cancer, is a type of cancer that stays in the bladder’s lining and hasn’t spread deeper into the bladder wall.

About 1 in 4 people with bladder cancer have a type that grows into the bladder muscle (stages T2–T4). This kind of cancer is more likely to spread to other parts of the body and needs stronger treatment. If not treated, it can be deadly.

If your bladder cancer has spread to other parts of your body, treatment is unlikely to cure it. The goal will be to control the spread of the cancer and help reduce symptoms.

When bladder cancer spreads to the bones, it can cause problems like weakened bones or fractures from minor incidents or everyday activities. This can lead to pain and affect your quality of life.

Your doctor may suggest radiation or medication to help make your bones stronger and control the pain.

If your cancer has spread or if it keeps coming, especially if your previous chemotherapy didn’t work, you should think about joining a clinical trial.

There aren’t many studies right now, but more are being done. These trials are available for both patients who haven’t had chemotherapy yet and those who have already been treated. Also, recent tests with drugs called "immune checkpoint inhibitors" are showing good results for some patients with advanced bladder cancer.

A clinical trial is a study that tests new treatments, medicines, or medical devices to see if they work well and are safe. It helps doctors find better ways to treat diseases. In a clinical trial, patients might receive the new treatment being tested or the standard treatment to compare the results. The goal is to improve patient care.

If the goal of treatment is to slow the cancer and control the symptoms, it can be very difficult to decide which treatment is right for you, or even whether to have treatment at all.

You will need a clear understanding of what drug treatment can do for you at this stage and how it will affect your quality of life.

Talk to family or friends and people who are close to you. Talking to someone outside your close circle can be helpful. Your doctor may be able to refer you to a counsellor or a nurse who specialises in your care.

There are patient groups to help bladder cancer patients. Ask your doctor if there is one in your area.

Questions to ask you doctor

Asking questions helps you understand your treatment plan better and gives you the information you need to make the best decisions about your care.

• What treatment options do I have for bladder cancer?
• What is the goal of my treatment (e.g., to cure the cancer, control it, or relieve symptoms)?
• What side effects could I have from the treatments you’re suggesting?
• How will this treatment affect my daily life?
• How long will my treatment last?
• How should I get ready for treatment?
• Are there any clinical trials I could join?
• What are the chances the cancer will come back after treatment?
• What will happen if this treatment doesn’t work or if the cancer spreads?
• How often will I need follow-up appointments or tests after treatment?
• Should I make any lifestyle changes or do anything special during treatment?
• Will I need other treatments like surgery, chemotherapy, or radiation?
• Can you refer me to a support group or someone who can help me understand my treatment options?
• What signs of problems or side effects should I watch for during treatment?
• How can I control pain or discomfort from the cancer or treatment?

Local recurrence of bladder cancer

If the cancer has come back in the same area, usually in your bladder, it is called local recurrence of bladder cancer. This can happen after you've already had treatment, like surgery, but some cancer cells may have been missed, causing it to come back. If this happens, your doctor might suggest more treatment, like surgery, chemotherapy, or immunotherapy, to help control it.

Most local recurrences of bladder cancer happen within the first 2 years after treatment.

Distant recurrence of bladder cancer

If the cancer has spread to parts of your body outside the bladder, like the lungs, bones, liver, or lymph nodes, it is called distant recurrence of bladder cancer. This can happen after your bladder has been removed.

Distant recurrence can usually only be treated with chemotherapy. If there are just one or a few spots where the cancer has spread, surgery might be an option to remove them, along with chemotherapy.

Distant recurrence usually happens within the first 2 years after bladder removal.

There might be clinical trials that could help with your situations. Talk to your doctor about it.

Asking our doctor questions about bladder cancer helps you understand your condition and treatment better. It gives you important information so you can make informed choices about your care. It also helps you know what to expect, like possible side effects or changes to your daily life, and how to manage them.

Here are some important questions to ask your doctor about bladder cancer:

• What kind of bladder cancer do I have?
• Has the cancer spread, and if so, where?
• What stage is my cancer, and what does that mean?
• What treatment options do I have?
• What are the pros and cons of each treatment?
• What happens if I decide not to have treatment?
• Are there support groups or counsellors I can talk to?
• Are there any clinical trials I should think about?

This chapter contains general information about treatment options for bladder cancer. If you have any specific questions about your own medical situation you should consult your doctor or other professional healthcare provider. No website or leaflet can replace a personal conversation with your doctor.

Last updated: March 2025