Overview

Bladder cancer treatment has advanced dramatically over the past decade. Patients today have more options, improved survival rates, and better quality of life compared to previous generations. Treatment varies depending on the stage of the cancer, the tumor’s grade, overall health, and whether the cancer is non–muscle-invasive or muscle-invasive.

Early-stage disease often focuses on preserving the bladder, using localized therapies and minimally invasive procedures. More advanced stages require aggressive treatment, sometimes involving removal of the bladder, immunotherapy, chemotherapy, or combination therapies. Understanding these treatment options empowers patients to make informed decisions and helps families support their loved ones through every step of care.

Surgery

Surgery remains one of the primary treatment methods for bladder cancer, especially when cancer is detected early or is confined to the bladder. There are several surgical options, each tailored to the tumor’s size, stage, and location.

For non–muscle-invasive bladder cancer, the most common procedure is Transurethral Resection of Bladder Tumor (TURBT). Done through the urethra, TURBT removes visible tumors and allows pathologists to determine tumor grade and depth. After TURBT, many patients receive intravesical therapy to prevent recurrence.

For muscle-invasive cancer, surgery becomes more extensive. The standard operation is radical cystectomy, which involves removal of the entire bladder and surrounding tissues. In men, this typically includes the prostate and seminal vesicles. In women, it often includes the uterus, ovaries, fallopian tubes, and part of the vaginal wall.

Partial cystectomy may be an option for select patients with tumors in limited areas of the bladder, allowing some of the bladder to be preserved. After bladder removal, reconstructive surgery such as a neobladder, urostomy, or continent reservoir helps restore urine passage.

TURBT

Transurethral Resection of Bladder Tumor (TURBT) is the foundation of treatment for early-stage bladder cancer. It is both a diagnostic and therapeutic procedure. By inserting a device through the urethra, surgeons remove tumors without external incisions, which minimizes discomfort and recovery time.

TURBT determines:

  • Whether cancer is present

  • Tumor type

  • Tumor grade

  • Depth of invasion

Many patients undergo multiple TURBT procedures during their treatment journey, especially when tumors recur. TURBT is critical because early-stage bladder cancer has a high recurrence rate. Following resection, doctors frequently apply intravesical therapies to reduce the risk of recurrence and progression.

Intravesical Therapy

Intravesical therapy delivers medication directly into the bladder through a catheter. This allows drugs to bathe the bladder lining while minimizing systemic side effects. Two major forms of intravesical therapy exist: immunotherapy and chemotherapy.

One of the most effective treatments for early bladder cancer is BCG (Bacillus Calmette-Guérin), a type of immunotherapy placed directly into the bladder. BCG stimulates the body’s immune system to attack cancer cells and has been the gold standard for treating high-grade non–muscle-invasive bladder cancer for decades.

Intravesical chemotherapy, such as mitomycin C or gemcitabine, may be used after TURBT to destroy residual cancer cells. It is often recommended when BCG is not suitable or available.

Treatment is usually delivered once weekly for several weeks, followed by maintenance schedules depending on response. Intravesical therapy significantly reduces recurrence and helps prevent early-stage cancer from becoming muscle-invasive.

Cystectomy

When bladder cancer invades the muscle layer or is at high risk of progressing, radical cystectomy becomes one of the most effective treatments. This surgery removes the bladder along with nearby organs that may contain cancer cells.

In addition to removing the bladder, cystectomy includes:

  • Removal of pelvic lymph nodes

  • Removal of the prostate in men

  • Removal of female reproductive organs in women

Recovery is extensive, but advancements in surgical techniques—including robotic cystectomy—have improved outcomes and shortened hospital stays.

After bladder removal, the surgeon must create a new way for urine to leave the body. Options for reconstruction include:

  • Ileal conduit (urostomy) — simplest method using a bag outside the body

  • Continent cutaneous reservoir — internal pouch emptied with a catheter

  • Neobladder — internal bladder-like structure allowing urination through the urethra

Cystectomy remains one of the most effective treatments for achieving long-term cancer control in muscle-invasive disease.

Chemotherapy

Chemotherapy plays an essential role at different stages of bladder cancer treatment. It may be used:

  • Before surgery (neoadjuvant) to shrink tumors

  • After surgery (adjuvant) to kill remaining cancer cells

  • As primary treatment when surgery is not possible

  • For metastatic cancer to slow progression

Common chemotherapy drugs for bladder cancer include cisplatin, gemcitabine, methotrexate, vinblastine, and doxorubicin. Combination regimens such as MVAC or gemcitabine-cisplatin are widely used and have shown to improve survival.

Neoadjuvant chemotherapy before cystectomy has become standard of care because it improves surgical outcomes and increases long-term survival rates. Not all patients are candidates for chemotherapy, especially those with kidney problems or other significant health issues.

Chemotherapy may also be combined with radiation for patients seeking bladder preservation. Managing side effects such as fatigue, nausea, low blood counts, and hair loss is an important part of treatment.

Radiation

Radiation therapy uses high-energy beams to destroy cancer cells. It is often used:

  • When surgery is not an option

  • Together with chemotherapy for bladder preservation

  • After TURBT to target lingering cancer cells

  • For pain relief in advanced cancer

Radiation alone may not be as effective as surgery for muscle-invasive bladder cancer, but when combined with chemotherapy, it can offer bladder-sparing treatment with good long-term results. This strategy is often called trimodal therapy, which includes:

  • TURBT

  • Chemotherapy

  • Radiation

Radiation is also valuable for managing symptoms in metastatic disease, particularly when cancer spreads to bones or causes pelvic pain.

Immunotherapy

Immunotherapy has revolutionized bladder cancer treatment, especially for patients with advanced or metastatic disease. Instead of attacking cancer cells directly, immunotherapy boosts the body’s immune system so it can better recognize and destroy tumors.

The most common immunotherapies for bladder cancer are checkpoint inhibitors, which block proteins that prevent immune cells from attacking cancer. These drugs include pembrolizumab, nivolumab, atezolizumab, avelumab, and durvalumab.

Immunotherapy is especially useful for:

  • Patients who cannot tolerate chemotherapy

  • Patients whose cancer did not respond to chemotherapy

  • Recurring or spreading bladder cancer

  • Certain high-risk early-stage cancers

Some patients experience durable, long-lasting responses. While not all tumors respond, immunotherapy continues to expand treatment possibilities and is now a major component of bladder cancer care.

Targeted Therapy

Targeted therapy focuses on specific genetic changes or molecular pathways that drive tumor growth. Unlike chemotherapy, which affects both healthy and cancerous cells, targeted therapy acts on cancer cells with particular vulnerabilities.

A notable example is erdafitinib, used for bladder cancers with FGFR genetic mutations. Patients undergo genetic testing to determine whether their tumor has this mutation. If present, targeted therapy may slow cancer progression and improve survival.

Targeted therapy is especially promising because it aligns with precision medicine, offering treatments tailored to each patient’s specific cancer biology.

Follow-Up Care

After treatment, bladder cancer patients require close follow-up because the disease has a high risk of recurrence. Follow-up care varies depending on the original tumor stage and treatment type.

Common follow-up strategies include:

  • Regular cystoscopy exams

  • Urine cytology

  • CT or MRI scans

  • Blood tests

  • Monitoring for urinary symptoms

  • Checking kidney function

Patients with neobladders or urinary diversions require additional monitoring to ensure proper function and to prevent infections or complications. Follow-up care supports long-term survival and early detection of any new cancer growth.

Choosing Treatment

Choosing the right treatment involves collaboration between patients, oncologists, surgeons, and healthcare teams. Key factors influencing treatment decisions include:

  • Cancer stage and grade

  • Patient age

  • Overall health

  • Kidney function

  • Genetic markers

  • Personal preferences (for bladder preservation vs. removal)

Shared decision-making allows patients to weigh the benefits and risks of each option. No single treatment is right for everyone. Personalized plans create the best outcomes.