Memorial Sloan Kettering medical oncologist Dean Bajorin explains that bladder cancer treatment is based on the grade of the tumor (which is based on how the cells look under the microscope and the risk that the tumor will spread), its location, and the extent of the disease.
A low-grade, superficial tumor has a low risk of spreading and can be removed through a procedure called transurethral resection. Patients with this type of tumor are monitored every few months with cystoscopy. To reduce the risk of recurrence, the bladder may be treated with chemotherapy or with a medication called BCG, which stimulates the immune system. This treatment, which was developed at Memorial Sloan Kettering, is infused into the bladder once a week for six weeks.
A combination of therapies is used to treat high-grade bladder tumors that have the potential to spread, especially those that have already invaded the muscle wall. Radiation oncologist Marisa Kollmeier says that some patients are candidates for a bladder-preserving treatment in which low-dose chemotherapy is used to enhance the effects of radiation therapy. Memorial Sloan Kettering’s radiation oncology team uses the latest techniques to ensure the safety and effectiveness of radiation therapy for patients. Patients with extensive disease may require systemic chemotherapy followed by surgery to remove the bladder and reconstruct the urinary tract.
Radical cystectomy may offer better outcomes for people with invasive tumors throughout the bladder. In addition to removing the bladder, this procedure involves removal of other genitourinary organs, as well as pelvic lymph nodes, followed by reconstruction of the urinary tract. Patient outcomes and survival are better when all of the lymph nodes are removed, and when patients receive care from a multidisciplinary team with experience in treating bladder cancer. In some cases, the surgeon can remove part of the bladder and monitor patients regularly with cystoscopy.