Treatment for bladder cancer

About your treatment

Treatment for bladder cancer depends on whether the cancer is:

Non-muscle-invasive

The cancer cells are in the inner lining or the connective tissue that surrounds the inner lining of the bladder. They have not spread into the muscle layer.
Muscle-invasive

The cancer is in the muscle layer of the bladder or has spread through the muscle into the fat layer. It has not spread outside the bladder.
Locally advanced

The cancer has spread outside the bladder into nearby tissues, the prostate, vagina, ovaries, womb or back passage (rectum). It may also be in lymph nodes in the pelvis, near the bladder.
Advanced

The cancer has spread to other parts of the body.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your cancer doctor or nurse will talk to you about different treatment options and things to think about when making treatment decisions. You can then decide together what treatment is best for you.

Your treatment options will depend on the stage of the cancer and your general health. You may have some treatments as part of a clinical trial.

Before you make any treatment decisions, your doctor or nurse will explain:

what each treatment involves
how it may affect your life
its advantages and disadvantages.

Take some time to think about the information you have and ask more questions if you need to. You may find it helpful to look at our information about making decisions about bladder cancer treatment.

We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our bladder cancer forum to talk with people who have been affected by bladder cancer, share your experience, and ask an expert your questions.

Contraception and fertility

Your doctor may ask you to use contraception to prevent pregnancy during and after some treatments. This is important because some treatments may harm a developing baby

Some treatments can affect your fertility. This means being able to get pregnant or make someone pregnant. Your doctor or nurse can explain if your treatment is likely to cause fertility problems. If you are worried about this, talk to your doctor before your treatment starts.

Stop smoking

If you smoke, your doctor will usually advise you to stop. If you do not stop smoking, this should not affect the treatment plan your doctors offer you. But stopping smoking can:

make your treatment more effective
reduce the side effects of treatment
reduce the risk of bladder cancer coming back.

Your hospital doctor or GP can offer different treatments to help you stop. Your hospital doctor, nurse or GP can refer you to a stop-smoking service in your area.

We have more information on giving up smoking.

Related pages

Bladder cancer

Treating non-muscle-invasive bladder cancer

Treatment for non-muscle-invasive bladder cancer usually depends on what risk level the tumour is. This means the risk of the cancer spreading into the muscle of the bladder or the risk of it coming back. To decide the risk level, your doctor looks at:

the size of the tumour
how far the tumour has grown into the bladder (T stage)
how many tumours there are
the grade of the tumour
if you have already had non-muscle-invasive bladder cancer in the last year.

Non-muscle-invasive bladder cancer can be grouped into:

low-risk
intermediate-risk
high-risk.

Your doctor or specialist nurse can give you more information about risk groups.

Surgery to remove non-muscle-invasive bladder cancer

Surgery is the main treatment for non-muscle-invasive bladder cancer. Most people have an operation called a transurethral resection of the bladder tumour (TURBT).

You usually have chemotherapy into the bladder (intravesical) immediately after surgery. You can usually go home once the catheter is removed and you have passed urine. This may be on the same day as your operation or 1 to 3 days after.

Further treatment for non-muscle-invasive bladder cancer

If you have a low-risk tumour, you will have a TURBT and chemotherapy into the bladder (intravesical) straight after this. You will not need any further treatment.

If you have an intermediate or high-risk tumour, you usually need further treatment with chemotherapy or an immunotherapy drug called BCG. Both are given into the bladder. High-risk bladder cancer is usually treated with BCG.

Your doctor may suggest having surgery to remove the bladder if you have a high-risk cancer and further treatments are not working.

This surgery is called a cystectomy. This can be a difficult decision to make. It is important to talk to your doctor about all your treatment options and what support is available to you.

Other treatments for non-muscle-invasive bladder cancer

Sometimes other treatments are used to treat non-muscle-invasive bladder cancer. Your doctor or nurse will tell you if they are suitable for your situations. The following treatments may only be available at some hospitals:

Heated intravesical chemotherapy

For this treatment, a thin tube with a rounded end called a probe applies heat to the bladder lining, while chemotherapy is given into the bladder. Or a machine is used to heat the chemotherapy before it goes into the bladder.
Electromotive intravesical chemotherapy

For this treatment a small electrical current is given into the bladder at the same time as the chemotherapy. This helps the cancer cells absorb more of the chemotherapy drug. This treatment is also called electromotive drug administration (EMDA).

A nurse puts a catheter into the bladder. This catheter contains a wire which is attached to a small machine. Your doctor or nurse usually puts 2 electrode pads on the skin of the tummy (abdomen). These are also attached to the small machine. The chemotherapy is put into the bladder through the catheter. After this, they switch on the machine and it delivers the electrical current.

Sometimes, this treatment is combined with having BCG into the bladder.
Tumour ablation

This treatment uses a laser called an infra-red light during a flexible cystoscopy to burn any areas of cancer away.

This treatment is only available for certain non-muscle-invasive bladder tumours. Your doctor will refer you if they think this treatment may work for you.

Immunotherapies

Some treatments may be offered as part of a clinical trial. This includes immunotherapies.

Immunotherapy drugs use the body’s immune system to find and attack cancer cells. These are being tested for non-muscle-invasive bladder cancer. You have this into a vein (IV). You may be offered these as part of a clinical trial.

If your urologist thinks a clinical trial may be helpful for you, they can refer you to the hospital doing the trial.

Coping with bladder problems during and after treatment

Your doctor or nurse will go over any side effects of treatment. During any treatment for non-invasive bladder cancer, you may have symptoms such as:

passing urine (peeing) more often
rushing to the toilet to pass urine
blood in your urine (pee)
a burning sensation when you pass urine.

For most people, these symptoms last for a few days after treatment. Your doctor or nurse can talk to you about things you can do to help. They will give you medication if needed.

Some people can have problems controlling their bladder during and for some time after treatment. This is called urinary incontinence. This can be a rare side effect of having lots of cystoscopies.

It is important that you talk to your doctor or nurse if this is a problem for you. They may refer you to a continence adviser or specialist physiotherapist who can give you advice. The Bladder and Bowel Community can also help.

We have more information about using public toilets.

If non-muscle-invasive bladder cancer comes back

It is not uncommon for non-muscle-invasive bladder cancer to come back. If this happens it can usually be cured or controlled for a long time. It can usually be treated with surgery called TURBT to remove it again. Some people may also have chemotherapy or BCG into the bladder.

Your doctor may talk to you about having an operation to remove the bladder (cystectomy). This may be when:

the cancer keeps coming back and further treatments are not working
the cancer starts to grow into the muscle layer of the bladder – this is called muscle-invasive bladder cancer.

A cystectomy aims to treat the cancer before it goes into or spreads further in the muscle of the bladder.

It can be hard to hear you need to have your bladder removed. Urologists will always consider the different treatments available to try to keep your bladder. With help from family members, friends, health professionals and support organisations, people usually manage to cope well with a cystectomy.

We have more information about having a having a cystectomy.

Treating muscle-invasive bladder cancer

Muscle-invasive cancer is cancer that has spread into or through the muscle layer of the bladder wall. Treatment usually aims to cure the cancer with one of the following:

Cystectomy

A radical cystectomy is surgery to remove the bladder. At the same time the surgeon makes a new way for you to pass urine (pee). This is called a urinary diversion. You may also have chemotherapy before or after the operation. This helps reduce the risk of cancer coming back.
Radical radiotherapy
Radiotherapy uses high-energy rays to destroy cancer cells. Radical radiotherapy means using high doses of this treatment to try and cure bladder cancer. Before radiotherapy you may have:

an operation to remove as much cancer as possible from inside the bladder using a cystoscope. This is called a transurethral resection of a bladder tumour or TURBT.

chemotherapy to shrink the cancer and reduce the risk of it coming back.

You then have the radiotherapy treatment. You may also have chemotherapy or other drugs during the radiotherapy treatment. This helps the radiotherapy to be more effective.

Your doctor may ask you to choose between these treatments as they can both be effective. They may also offer you treatment as part of a clinical trial. We have more information about making treatment decisions.

Some people with locally advanced bladder cancer may also be offered these treatments. Locally advanced means the cancer has spread outside the bladder into nearby areas.

If a cure is not possible, treatment can be given to control the cancer to help you live longer and reduce symptoms.

If muscle-invasive or locally advanced bladder cancer comes back

If the cancer comes back, you can usually have more treatment. The type of treatment you have will depend on:

where it has come back
the treatment you had before.

If the cancer comes back after radiotherapy, some people may be able to have surgery to remove their bladder. This is called a cystectomy. If you have had your bladder removed, other treatments can be used. Your doctor will talk to you about the treatment that is best for your situation and ask about your preferences.

Finding out that cancer has come back can be a shock. Everyone has their own way of coping with this. Our cancer support specialists can also give you information and emotional support. Call the support line for free on 0808 808 00 00.

Treating locally advanced bladder cancer

Locally advanced means the cancer has spread outside the bladder into nearby areas of the body.

The best treatment depends on the areas of the body that are affected. Some people will have treatment that aims to cure the cancer. There is more information about this under the ‘Treating muscle-invasive bladder cancer’ heading above.

Others will have treatment that aims to control the cancer and any symptoms it is causing. There is more information about this under the ‘Treating advanced bladder cancer and symptoms’ heading below.

Treating advanced bladder cancer

Advanced bladder cancer means cancer that has spread from the bladder to other parts of the body. Sometimes this is called metastatic bladder cancer.

Unfortunately it is not possible to cure advanced bladder cancer. Treatment aims to:

shrink or control the cancer and help you live longer
reduce your symptoms
improve your quality of life.

This is called supportive treatment or palliative treatment,

Your doctor will explain the different treatment options and their side effects. They will consider what is important to you and how treatment may affect you. You and your doctor decide together on the best treatment plan for you.

Always let your doctor or specialist nurse know if you have new symptoms, or if your symptoms get worse.

You may have one or more of the following treatments:

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy into a vein to help control and improve your symptoms.
Immunotherapies

Immunotherapy drugs use the immune system to find and attack cancer cells. A type of immunotherapy called checkpoint inhibitors are sometimes used instead of, or after, chemotherapy. You may be offered some treatments as part of a clinical trial.
Radiotherapy

Radiotherapy uses high-energy rays to treat cancer cells. You may have radiotherapy to treat bladder symptoms, such as pain or bleeding. It may be given as 3 to 5 treatments over a week or sometimes as 1 single treatment. Each treatment takes around 10 to 15 minutes.

Radiotherapy can also be used to treat pain if the cancer has spread to the bones. You may only need 1 treatment or up to 5 treatments.
Bone-strengthening drugs

You may have drugs called bisphosphonates or a drug called denosumab if bladder cancer has spread to the bones. These drugs help strengthen the bones and may reduce bone pain.
Ureteric stent

Sometimes, bladder cancer can block the tube called the ureter between the kidney and the bladder. Your doctor may suggest an operation to put a tube called a stent in to open the ureter. This is called a ureteric stent.
Nephrostomy

A nephrostomy is a tube that lets urine (pee) drain from the kidney through an opening in the skin on your back. The tube is attached to a drainage bag outside the body. Your doctor may suggest an operation to insert a nephrostomy if it is not possible to put in a ureteric stent.

Your cancer doctor or nurse may also suggest other ways to relieve and control symptoms. We have more information about managing symptoms such as:

Your cancer doctor or GP may refer you to a palliative care team. This is an expert team that helps manage symptoms, such as pain or nausea. There are palliative care teams based in hospitals, hospices or in the community.

Coping with advanced cancer

Finding out you have advanced cancer can be difficult to cope with. You may feel shocked and find it hard to understand. Or you may have questions about what to expect. Your doctor and specialist nurse are there to help. We have more information about coping with advanced cancer that you may find helpful.

About our information

References

Below is a sample of the sources used in our bladder cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Mottet N, Bellmunt J, Briers E, et al. Non-muscle-invasive bladder cancer (TaT1 and CIS). European Association of Urology (Internet), 2021. Available from uroweb.org/guideline/non-muscle-invasive-bladder-cancer (accessed September 2021).

Witjes JA, Bruins HM, Cathomas R, et al. Muscle-invasive and metastatic bladder cancer. European Association of Urology (Internet), 2021, Available from uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic (accessed September 2021).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.