Types of treatment for invasive bladder cancer

Invasive bladder cancer means that the cancer cells have spread beyond the inner lining and into the muscle layer of the bladder. There is a risk that the cancer could spread to other areas of the body if it is not treated.

If you have invasive bladder cancer you will need to have one of the following treatments

• Surgery to remove part of the bladder
• Surgery to remove the whole bladder
• Radiotherapy

You may also have chemotherapy before or after your surgery or radiotherapy, because this can increase the chance of curing the cancer. The idea of chemotherapy before your other treatment is to 

• Try to make the cancer smaller
• Increase the success of radiotherapy or surgery
• Treat any cancer that has spread outside your bladder

If you have surgery and there is a high risk of the cancer coming back afterwards, your doctor may recommend that you have chemotherapy to reduce the risk of recurrence.

Some doctors recommend radiotherapy for invasive bladder cancer. Other doctors recommend surgery. A large research study in Glasgow reported in 2007. The study suggested that for most people radiotherapy works as well as removing the whole bladder in treating invasive bladder cancer. You can read these surgery compared to radiotherapy trial results on our clinical trials database. 

But radiotherapy is not recommended in the following situations

• Squamous cell bladder cancer
• If there is CIS in much of the bladder lining as well as invasive cancer
• If the cancer is not responding to initial chemotherapy
• If the cancer is blocking both ureters

You will need to talk to your specialist about the risks and benefits of surgery or radiotherapy in your case. Your doctor will discuss your treatment options with a team of people who specialise in treating bladder cancer (the multidisciplinary team). The team includes a radiologist, pathologist, surgeon, radiotherapy and chemotherapy doctors, and specialist nurses. You may need to meet with one or more of these specialists to discuss your options. The team will recommend the best options to treat your cancer. The final decision about which treatment you have is up to you.

The main benefit of radiotherapy is that you don't need to have your bladder removed. The bladder usually shrinks though, so you may find you need to pass urine more often. Radiotherapy means going into the hospital each weekday for 6 to 7 weeks to have the treatment. 

Radiotherapy can also cause short term inflammation of the bowel, which can cause diarrhoea and may be long term for some people. Researchers have been looking into giving chemotherapy and radiotherapy at the same time. This is called concurrent chemoradiation. The aim is to try to keep the bladder working normally and reduce the need for surgery. 

If the cancer comes back in the bladder area after radiotherapy, you will need to have surgery to remove the bladder because you will not be able to have more radiotherapy.

Surgery for invasive bladder cancer means having quite a big operation. There is information about the different types of surgery for bladder cancer in this section of CancerHelp UK. The techniques for surgery for bladder cancer have been improving over many years. 

If you need to have your whole bladder removed, you may be able to have an operation to create a new bladder. With some operations you have to have a waterproof bag (urostomy bag) on your tummy (abdomen) to collect the urine afterwards. 

If the cancer comes back after surgery, you may have treatment with chemotherapy into a vein or radiotherapy to the bladder area. You will need to talk to your doctor about these different treatments to find out why they think one or the other may be best for you. 

With radiotherapy or surgery there is a 50% chance that the cancer will come back in the bladder some time after treatment. You will then need to have further treatment.

There is detailed information about these treatments in this section of CancerHelp UK to help you make up your mind which to have.