Treatment for Bladder Cancer

All types and stages of bladder cancer and other urinary tract cancers are treatable. The key is to get care from experts who know the complex factors that go into choosing the right treatments for you at the right time — like the physicians at Fred Hutchinson Cancer Center.

Our bladder cancer specialists work closely with you, your family and each other to get you back to health. At Fred Hutch, we provide all standard therapies for bladder and other urothelial cancers and offer you access to the latest innovations through clinical trials. We treat even the rarest forms of bladder cancer. Our physicians are internationally known for their expertise and experience.

Treatment Plan

Treatment for bladder and other urothelial cancers is highly customized for each patient’s needs.

How Do We Create Your Treatment Plan?

Your Fred Hutch doctors work with an entire group that specializes in bladder cancer and other cancers of the urinary tract. They include urologic oncologists, medical oncologists, radiation oncologists, pathologists, radiologists and researchers who are all looking for better ways to treat this disease.

In our Bladder Cancer Multispecialty Clinic (BCMC), this team gathers every week in a meeting called a tumor board. Together, dozens of team members discuss their patients’ treatment plans. This approach means BCMC patients benefit from the experience of the whole group. 

With support from the larger team, your doctors will:

  • Talk about all possible treatments for your situation
  • Decide which therapies will be most promising for you
  • Check if any clinical trials match your needs, so you can think about joining them

Your care team will walk you and your caregiver through the treatment plan we recommend for you. You will have a chance to share your personal preferences, and you will decide together what happens next.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many factors, including:

  • The type, stage and grade of your cancer
  • The size and location of your tumor
  • The molecular profile (make-up) of the cancer, which helps us tell if the cancer is likely to respond to certain therapies
  • Your age, overall health and other medical issues
  • Your needs, goals and preferences, like if you want to join a clinical trial that may be right for you

What Is The Standard Therapy For Bladder Cancer?

Treatment for bladder cancer can be very different from person to person. However, the first treatment for non-muscle invasive cancer is usually surgery to remove the tumor, without removing the bladder. You may also have chemotherapy or immunotherapy in your bladder to reduce the risk of cancer coming back.

For muscle-invasive cancer that has not spread to distant parts of the body, patients often have surgery to remove the bladder and make a new path for urine to leave the body. You may have chemotherapy before surgery. Some people can avoid bladder removal by having chemotherapy and radiation therapy.

For metastatic cancer, the most common first treatment is chemotherapy. Other treatments, like immunotherapy, targeted therapy and other therapies, may help control the disease symptoms, shrink the tumor on imaging, slow down cancer growth, help you live longer and give you the best possible quality of life.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support as needed. These include integrative medicine, nutrition counseling, physical and occupational therapy, emotional support, genetic counseling to help you and your family with cancer prevention and care to reduce symptoms caused by the cancer or the treatments you receive.

Our patients can choose to receive promising, new bladder cancer therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.

Treatment Process

We choose, combine and schedule your treatments based on what works for cancer like yours. Your care team makes sure you understand each type of treatment and all of your choices. 

You may get your care at the South Lake Union Clinic, UW Medical Center - Montlake or both. This depends on which treatments you need. If you need more than one type of treatment, we will coordinate your care. Our Bladder Cancer Multispecialty Clinic makes coordination easy.


Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow). For localized muscle-invasive bladder cancer, you may have chemotherapy before or after surgery — or, in some cases, to try to save your bladder. If cancer has spread beyond your bladder, chemotherapy is the most common first treatment (and there are more treatment options). Your medical oncologist talks with you about the goals and the pros/cons of systemic therapy, prescribes it and sets your treatment schedule, based on the details of your cancer and your individual needs and wishes. 

Intravesicular Chemotherapy

After surgeons remove non-muscle invasive cancer, they often put chemotherapy into the patient’s bladder. The goals are to kill any cancer cells that are still there and reduce the risk of cancer coming back. The medicine is put in through a catheter. It is left for one to two hours. It is drained from your bladder before you leave the recovery room. 

Systemic Chemotherapy

Systemic chemotherapy is given by infusion (put into a vein). It travels throughout your body. 

It can be used:

  • Before or after surgery. This may improve the chance of a cure if your cancer has a high risk of spreading. It helps destroy microscopic cancer cells that might still be somewhere in the body after surgery and may not be visible on imaging.
  • To make cancer easier to remove with surgery. This may be helpful if you have large, locally advanced disease. 
  • To control the cancer and related symptoms, improve your quality of life and help you live longer if cancer has spread to distant parts of your body.

For an infusion, liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter), depending on the therapy. Treatment happens in repeating cycles.

You get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will also check on you during the treatment. They will handle any medical issues that come up and help keep you comfortable.


Surgery is the main treatment for non-muscle invasive bladder cancer. It is also an important option for muscle-invasive bladder cancer. You may have chemotherapy either before or after surgery for muscle-invasive bladder cancer.

Blue-Light Cystoscopy with Hexaminolevulinate Hcl 

Our urologic oncologists use state-of-the-art technology to see non-muscle invasive bladder cancers more easily. It is called blue-light cystoscopy with hexaminolevulinate HCl. We are the first site in Washington state to offer this technology.

In this approach, providers place a small amount of an imaging agent, hexaminolevulinate HCl, into the bladder. They do this through a catheter. Then, they put a cystoscope into the bladder through the urethra. The scope has both white and blue light. In the blue light, the imaging agent makes cancer cells glow pink. 

This allows us to find and remove more cases of bladder cancer. About 10–20 percent of bladder tumors are missed using the traditional white-light method.

Blue light also helps us get as many cancer cells as possible. Removing more cells lowers the risk that the disease will come back (recur). This approach reduces recurrence rates by 20 percent. It also helps patients live longer without recurrence.

Blue light cystoscopy (right) gives a pink glow to non-muscle invasive cancer cells. This makes them easier to see than with traditional white-light (left).
Blue light cystoscopy (right) gives a pink glow to non-muscle invasive cancer cells. This makes them easier to see than with traditional white-light (left).

Transurethral resection of a bladder tumor (TUR or TURBT)

This is the most common first treatment for non-muscle invasive bladder cancer. Non-muscle invasive cancer sits on the inside surface of your bladder or within the first lining. The surgeon puts a thin camera (resectoscope) into your bladder through your urethra. Then, they use a special wire loop to remove as much of the tumor as they can get safely.

Radical Cystectomy

This is surgery for cancer that has gone into your bladder muscle. The surgeon removes your entire bladder. They also remove nearby lymph nodes to keep the cancer from spreading further. Other organs, like the prostate, uterus, fallopian tubes, ovaries or part of the vagina, may also be removed.

There are both open methods, which are done through a larger incision (cut), and robot-assisted methods, which are done through small incisions. Your care team will talk with you in advance about your exact procedure. 

Our urologic oncologists do many more of these surgeries each year than surgeons anywhere else in the state. This means your care team has a great deal of experience. Research clearly shows that higher-volume centers like ours have better outcomes. 

Some people with muscle-invasive cancer can avoid surgery to remove their bladder. Instead, they can have chemotherapy and radiation therapy. We also offer this bladder-sparing treatment in certain cases based on particular cancer features.

Urinary Reconstruction

To allow urine to leave your body after radical cystectomy, surgeons will make a new drainage system. They do this using parts of your intestines. There are three options:

  • Orthotopic neobladder — The surgeon makes a new bladder that is connected to your urethra. You can urinate the same as you did before. 
  • Ileal conduit/loop — The surgeon makes an opening (stoma) in your abdomen. Urine can drain all the time into a pouch outside your body.
  • Continent cutaneous urinary reservoir — This is a storage system that you drain every few hours. You do this using a catheter that goes through an opening in your abdomen.

Robot-Assisted Surgery 

Fred Hutch and UW Medicine urologic oncologists do laparoscopic radical cystectomy using robotic technology. We did the first robot-assisted cystectomy in the region, and we lead the area in providing this type of care.

With this system, your surgeon uses hand and foot controls to move robotic arms. These arms hold a laparoscope (camera) and surgical tools. The system lets your surgeon make precise, complex motions and helps keep them from getting tired. This method is linked with less blood loss, less pain and better cosmetic results with the same success in cancer control.

Treatment Types

Targeted Therapy

For some bladder cancers, you may get targeted therapies. These are more exact than chemotherapy, which affects all fast-growing cells throughout the body.

Targeted therapies work in one of these ways:

  • They target a particular gene or protein that causes cancer growth.
  • They damage cancer cells directly based on a target in the cancer cells.

Like with chemotherapy, your medical oncologist will prescribe your targeted therapy. Some targeted therapies are a pill that you take at home. Others are given by infusion (put into a vein) in repeating cycles. 

Three targeted therapies for bladder cancer are erdafitinib (oral), enfortumab vedotin (infusion) and sacituzumab govitecan (infusion). The last two are targeted chemotherapies made of antibodies linked to drugs (antibody-drug conjugates). The antibodies deliver the drugs to certain cancer cells by finding and attaching to the cells. 

Other targeted therapies are being tested in clinical trials, and researchers are looking for more options. Your team may recommend this type of treatment if, for example, your bladder cancer gets worse after you have standard therapy or even as an initial therapy, depending on your case.

Learn More About Targeted Therapy


Immunotherapies, like BCG therapy, use the power of your immune system to find and fight cancer cells.

For non-muscle invasive bladder cancer, doctors may use liquid therapies that are put into your bladder through a catheter (intravesicular therapies). In BCG therapy, a liquid carrying the bacterium bacillus Calmette-Guérin (BCG) is put into your bladder several times over weeks or months. BCG does not usually cause illness. It helps your body’s natural defenses to see cancer cells and fight them. For precancerous lesions and non-muscle invasive cancers, this may control the disease and prevent more advanced cancer. Other intravesicular therapies may include chemotherapy and new therapies available through clinical trials.

For bladder cancer that has spread, we have medicines called immune checkpoint inhibitors. A healthy immune system attacks bacteria, viruses and sometimes harmful cells, like cancer cells. It is supposed to leave harmless cells alone. One way that cancer cells survive is by sending false signals that make them look harmless. 

Immune checkpoint inhibitors block cancer’s false signals. This allows your natural defenses to work better. Your team may recommend one of these medicines based on the exact features of your cancer, your overall health and any other medical issues you have.

Learn More About Immunotherapy

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It can be used with chemotherapy to make the radiation work better.

Your Fred Hutch team may recommend radiation therapy:

  • With chemotherapy, if cancer has gone into your bladder muscle layer or if you cannot have or would rather not have surgery
  • As a way to relieve pain and prevent other problems from cancer 

A radiation oncologist decides on the type, dose, field and schedule of your treatment. 

For bladder cancer, it is important to receive radiation therapy from a center, like Fred Hutch, that has a great deal of experience with this disease. In the 1980s, now-retired Fred Hutch physician Kenneth J. Russell, MD, was a pioneer in using radiation therapy for localized muscle-invasive bladder cancer. This allowed patients to keep their bladder instead of having it removed.

Learn More About Radiation Therapy

Monitoring Your Health

While you are in active treatment, your bladder cancer care team will see you regularly for exams and tests to check:

  • How well your treatment is working, like if it is shrinking the cancer
  • If there is any reason to pause, stop or change your treatment
  • If you need help with side effects or supportive care services, like nutrition care, physical or occupational therapy, palliative care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how the cancer responds, how therapy affects you and what you prefer.

Possible Results of Treatment

Throughout treatment, your care team looks for signs of:

  • Remission: Fewer signs and symptoms of cancer or less cancer burden (smaller tumor) on imaging. Partial remission means some signs and symptoms remain. Complete remission means there are no signs or symptoms, including no cancer shown on imaging.
  • Stable disease: No change in the extent of cancer burden on imaging (or symptom severity). The cancer is not getting better, but it is not getting worse, either.  
  • Disease progression: The cancer is getting worse or spreading.
  • Relapse: The cancer signs or symptoms have come back, or cancer is again present on imaging, after they had improved.
  • Refractory disease: The cancer gets resistant to treatment.

What about “cured”? Sometimes doctors use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence could still be possible.

Managing Side Effects

You might be wondering about possible side effects from treatment. If you are, it may be helpful to know that the same physicians, nurses and advanced practice providers who treat your cancer are here to help prevent or relieve any side effects. You are always at the center of everything we do. 

Get Help with Side Effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects. Good communication is important.

In between and at your appointments, we want you to tell us right away about any side effects you may be having. If you have any questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours if that is when you need us (we are available 24/7).

We have many tools to help you feel better, such as:

  • The best supportive medications to prevent and treat symptoms, like nausea, indigestion and itching
  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Physical therapy to help you recover from surgery
  • Conventional and integrative therapies for pain

Coping With Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other things, like how strong your immune system is. These are some of the common side effects of bladder cancer treatment: 

  • Unusual tiredness (fatigue)
  • Discomfort after surgery or changes in urination, like leakage or blockage
  • Hair loss
  • Problems in your digestive tract, like nausea, vomiting, diarrhea or constipation
  • Changes in appetite or taste
  • Skin problems, like rash, itching or dryness
  • Low blood cell counts, which can raise your risk for infection, easy bleeding and bruising, and fatigue
  • Changes in sexual feeling or function after bladder removal (radical cystectomy)

Other side effects may happen. Your doctors will talk with you to help you prepare and manage any side effects you may have.

Supportive Care Services

Along with treating your bladder cancer, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need in a timely manner. 

If you would like to talk with other Fred Hutch patients and caregivers who have gone through bladder cancer treatment, please ask your care team. We can help connect you. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is having surgery, chemotherapy, radiation therapy, immunotherapy or targeted therapy, there are many ways you can help. Caregiving during active treatment often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms 
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning

Continuing Care

When your cancer is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your disease. They will check your overall health and look for signs that your cancer may have come back (signs of recurrence).

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over). 

Schedule For Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your doctors will base your schedule on many things, including: 

  • Your cancer type, stage and grade
  • Which treatments you had and how the cancer responded 
  • How the cancer and treatments affected you 
  • How long it has been since your treatment ended

Most patients have follow-up appointments for at least five years. It is common to have visits more often in the first months and years after active treatment ends and less often as time goes on. You and your doctors will talk about the best plan for you.

What Happens at Follow-up Visits

Follow-up for bladder cancer usually means seeing your team to talk about how you feel and to have a physical exam, blood and urine tests, cystoscopy (if you still have your bladder) and computed tomography (CT) scans. 

If there is any cause for concern, you might have other tests or scans. Together, you and your doctor will go over the benefits and risks of any follow-up options and decide what is right for you at the right time.

Meet the Bladder Cancer Care Team