The bladder cancer experts at Columbia Cancer are national leaders. We have a long record of treating people with bladder cancer. We offer treatment that is designed for you and your preferences.
About 75% of people with bladder cancer have noninvasive disease—it hasn’t spread beyond the inner lining of the bladder. In this case, you’re eligible for less invasive treatments such as local surgery using a cystoscope, followed by close monitoring to catch recurrence or giving additional medications into the bladder.
A small percentage of people have more aggressive cancer. In this case, deciding the best treatment plan for you is more complex. Our goal is to preserve your bladder whenever possible and for as long as it is safe to do so. Many people are able to keep their bladders permanently. Some people also have chemotherapy and radiation therapy.
Here are the types of surgery you might have:
Transurethral surgery (TUR)
TUR is done with a cystoscope, a tube with a camera and a light that’s inserted into your bladder through your urethra. The scope has a wire loop at the end that your surgeon can use to remove suspicious tissues and tumors. They might also use a laser and other devices to destroy the tumor–called fulguration.
Cystectomy is sometimes needed to treat more invasive bladder cancers. It involves removing part or all of your bladder, plus nearby associated tissues and organs.
- Partial cystectomy removes part of your bladder but leaves enough of the organ intact to function normally. This operation is generally done if cancer has invaded just part of the bladder wall and if you might not tolerate complete bladder removal.
- Radical cystectomy is used when cancer has spread farther into your bladder. Surgeons will remove your bladder, nearby lymph nodes, part of your urethra (the tube leading outside your body from your bladder), and nearby organs that may contain cancer cells.
We offer minimally invasive bladder surgery using the da Vinci robot. This is a high-tech system that uses a magnifying camera and miniature surgical instruments for precise control. People who have minimally invasive surgery are generally in the hospital for a shorter time, have less pain, lose less blood, and have smaller incisions.
Reconstructive bladder surgery (neobladder)
If your bladder cancer is invasive, it’s more likely that you will have your entire bladder removed. In this case, our surgeons will fashion a urinary diversion for you using a piece of your intestine. There are several types of urinary diversion:
- Neobladder: Your surgeon creates a new bladder using a small portion of your small intestine. Then they connect this to your urethra so you can urinate in a more normal manner. Our surgeons have been at the forefront of this type of surgery for decades.
- Catheterizable pouch: If your surgeon can’t create a neobladder, they will create an internal reservoir that is connected to an opening in your abdomen. You’ll empty this reservoir several times a day using a catheter.
- Ileal conduit: This type of urinary diversion is constructed by connecting a small piece of your intestine to your abdominal wall. Urine will then drain through the ileal conduit into a bag that is secured to your skin.
Many patients with nonmuscle invasive bladder cancer benefit from medications instilled into their bladder to help prevent the cancer from coming back.
Immediately after a transurethral surgery (TUR), your surgeon may recommend giving a single dose of chemotherapy into your bladder before you leave the hospital. Chemotherapy is a chemical that kills cancer cells. An immediate dose of chemotherapy after TUR is an effective treatment that decreases recurrence rates and is well tolerated.
Patients with high grade nonmuscle invasive bladder cancer are usually recommended to have an intravesical immunotherapy using a medication called Bacillus Calmette-Guerin (BCG). This medication is instilled in your bladder weekly for six weeks in our clinic. BCG helps your immune system attack the tumor cells. This is the most effective drug for preventing recurrence of high grade nonmuscle invasive bladder cancer.
Some people do not respond to intravesical BCG and may be recommended to have their bladder removed. An alternative to bladder removal in this setting is delivering other chemotherapies into the bladder. Our researchers have pioneered an exciting new treatment that could allow you to keep your bladder by placing a chemotherapy drug combination called cabazitaxel, gemcitabine, and cisplatin (CGC) inside the bladder.
Immunotherapy drugs stimulate your own immune system to defend against cancer. Checkpoint inhibitors are a type of immunotherapy that release a brake on the immune system. These drugs work by blocking the interaction of two molecules, called PD-1 and PD-L1, on the surface of cancer cells. This blocks the immune system “off switch,” allowing the body’s immune cells, called T-cells, to recognize and attack the tumor cells.
There are several checkpoint inhibitor drugs that are FDA-approved for the treatment of bladder cancer. We also offer many clinical trials investigating new checkpoint inhibitors for bladder cancer. You should talk to your doctor about any potential options.
Chemotherapy is the most commonly known cancer treatment. Chemotherapy uses chemicals (medicines) to stop cancer growth and spread and prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die.
If you are having your bladder removed, you’ll likely receive systemic chemotherapy. Usually, you’ll have chemo before surgery, because the best research to date shows it’s most effective. This is called neoadjuvant therapy. In some cases, people may have chemo after surgery (adjuvant therapy).Chemotherapy is also used if the disease has spread to other organs. Because chemo interferes with all fast-dividing cells in your body it causes side effects like hair loss and stomach upset.
You’ll receive this type of chemotherapy through an IV in our infusion center or through a pill.
Your doctor may also consider treating you with a recently approved antibody-based drug that delivers molecules of chemotherapy directly to your cancer cells (antibody drug conjugate). This therapy was recently FDA-approved and is often used if your cancer has spread beyond the bladder (metastasized).
The field of bladder cancer care is ever-evolving and now includes a drug that can treat cancers that have specific genetic mutations or protein fusions. This drug is specific for certain gene mutations. Your doctor will speak more with you if this therapy is an option.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as x-rays, gamma rays, electron beams, or protons. Radiation oncologists direct these particles from outside of your body to precisely target cancer cells, often sparing nearby tissue.
Radiation can shrink a tumor before surgery to make the procedure easier to perform. It can also help select people preserve their bladder. Radiation is often used with systemic chemotherapy and aggressive surgery (TUR) to remove as much tumor as possible.
External beam radiation therapy is the most commonly used form of radiation to treat bladder cancer. You’ll usually have 30-minute treatments every day, five days a week for several weeks.