Treatments and Therapies for Bladder Cancer

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Fred Hutch Cancer Center offers comprehensive care for bladder cancer. We offer advanced treatments and new options available only through clinical trials. The most common treatments for bladder cancer are chemotherapy, surgery, immunotherapy, radiation therapy and targeted therapy. Often, patients have a combination of treatments. But not everyone needs all of these. We’ll tailor your treatment to you.

At Fred Hutch, many people with bladder cancer see providers at our Bladder Cancer Multispecialty Clinic. At this clinic, located at UW Medical Center - Montlake, all the specialists who will be part of your care come together. In a meeting called a tumor board, they discuss treatment options and design a treatment plan to meet your needs. You will receive a multidisciplinary treatment plan in a single day. 

Bladder Cancer Care Tailored to You

You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services. 

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How We Treat Bladder Cancer at Fred Hutch 

Chemotherapy

Chemotherapy helps to destroy cancer cells wherever they may be in your body. Usually, it means you get anti-cancer medicine through an intravenous (IV) line. Then the medicine travels throughout your body through your bloodstream. 

Medical oncologists at Fred Hutch use chemotherapy to:

  • Help shrink tumors before surgery
  • Keep tumors from coming back after surgery
  • Control tumors that can’t be removed
Read About Chemotherapy for Bladder Cancer

Surgery

As a patient at Fred Hutch, you’ll have surgery by a UW Medicine urologic oncologist. Your surgeon will be specially trained and board certified in urologic surgery. They will recommend the best procedure to match your needs.

 

Read About Bladder Cancer Surgery

Immunotherapy

Immunotherapies are some of the latest innovations at Fred Hutch. They use the power of your immune system to fight your cancer. 

Your tissue biopsy can be tested to see if immunotherapy would be helpful for your cancer. 

Read About Immunotherapy for Bladder Cancer

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
  • To relieve pain and prevent other problems from cancer 

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

Learn About Radiation Therapy for Bladder Cancer

Targeted Therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. Targeted therapies work in one of three ways:

  • They target a gene or protein that causes cancer growth.
  • They damage cancer cells directly.
  • They tell your immune system to attack certain cells. This is also called immunotherapy.

These medicines are important if you have bladder cancer that has spread to other parts of your body (advanced or metastatic cancer).

Learn About Targeted Therapy for Bladder Cancer

What to Expect

When you come to Fred Hutch, we match you with the health care services and providers that are right for you. Your care here is always personalized. We tailor your first appointment — and all your visits with us — to your unique situation. 

The plan for your first appointment will depend on if your cancer:

  • Sits on or in the first lining of your bladder (non-muscle invasive, also called superficial or early-stage)
  • Goes into the muscle wall of your bladder (muscle invasive)
  • Has spread to distant parts of your body (metastatic)

We will also think about any treatment you have already had.

If you have a related cancer of the upper urinary tract, such as the ureter, renal pelvis or urethra, your first appointment will be similar to a visit for bladder cancer.

Non-Muscle Invasive Bladder Cancer With No Prior Treatment

If you have non-muscle invasive bladder cancer and you have not had treatment yet, our urologic oncologists are the experts who will plan and provide your care. Your first visit will be with this type of doctor. Most people in your situation have cystoscopy (a procedure to look inside the bladder and remove the tumor). This is often followed by chemotherapy that the surgeon puts directly into the bladder during the cystoscopy procedure. Your urologic oncologist will then decide if you need more treatments (BCG therapy or chemotherapy) directly in the bladder.

Non-Muscle Invasive Bladder Cancer With Prior BCG Therapy

If you have non-muscle invasive bladder cancer that did not respond to BCG therapy or came back after BCG therapy, you may need different types of treatment. These can include surgery, medicine-based options or radiation therapy. Our Bladder Cancer Multispecialty Clinic is designed for you. There, you will see several specialists in a single day. Together, they will recommend a complete, personalized treatment plan for you.

Muscle-Invasive, Nonmetastatic Bladder Cancer

If cancer has gone into the muscle wall of your bladder but has not spread to distant parts of your body, you may need two or more types of treatment. These can include surgery, medicine-based options or radiation therapy. Our Bladder Cancer Multispecialty Clinic is designed for you. There, you will see several specialists in a single day. Together, they will recommend a complete, personalized treatment plan for you.

Metastatic Bladder Cancer

If you have metastatic bladder cancer, our medical oncologists are the right match for your needs. They specialize in medicine-based treatments for bladder cancer and other cancers of the urinary tract. You will likely start by seeing one of them first. Most people in your situation need chemotherapy. They usually do not have surgery. They may have immunotherapy, targeted therapy or other treatment. Sometimes, they need radiation therapy to help with cancer-related symptoms.

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:

  • 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

Read more about 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.

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.

Why Choose Fred Hutch for Bladder Cancer Treatment 

At Fred Hutch, 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.

Team-Based Care from Specialists

Fred Hutch has urologic oncologists, medical oncologists and radiation oncologists who specialize in bladder cancer. We offer the most advanced diagnostic, treatment and recovery programs. Along with treating your cancer, we also offer a range of services to support you and your caregiver. This is part of how we take care of you — not just your disease. From registered dietitians to chaplains to social workers, our experts know how to care for people with bladder cancer.

Treatment Tailored to You

We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options. We’ll recommend a treatment plan to get you the best results based on the stage and size of your cancer, where it is and your overall health.

Clinical Trials to Improve Outcomes

Many of our patients receive promising therapies by taking part in bladder cancer clinical trials. These research studies are done by physician-scientists from Fred Hutch and UW Medicine. They test new treatments or new ways to use current treatments. Every advance in cancer treatment in recent years has come out of clinical trials. Through the Cancer Consortium, we typically have more than 750 active clinical trials, which means more treatment options for people like you.

Bladder Cancer Treatment FAQ

The most common treatments for bladder cancer are chemotherapy, surgery, immunotherapy, radiation therapy and targeted therapy. Often, patients have a combination of treatments. But not everyone needs all of these. We’ll tailor your treatment to you.

In general, people who have the same stage of bladder cancer often have the same or similar treatments.

Most people with bladder cancer begin treatment by having surgery to remove their cancer. If bladder cancer has spread beyond your bladder, you might have chemotherapy first. This can help treat cancer wherever it is.

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.

Fred Hutch offers all standard treatment for bladder cancer. Our patients also have access to newer options or treatment combinations that you can only get through clinical trials.

Fred Hutch researchers are always looking for better ways to treat bladder cancer. We are doing clinical trials of new drugs and drug combinations to treat different types of bladder tumors. Our scientists are also developing new methods to tell which tumors are likely to respond best to which treatments. 

Learn more about bladder cancer research.