Treatment

Surgery is the main treatment for noninvasive bladder cancer and an important option for invasive bladder cancer. Some people with invasive cancer can have chemotherapy and radiation therapy without surgery to remove their bladder (bladder-sparing treatment). SCCA patients have surgery at University of Washington Medical Center.

Blue light cystoscopy (BLC) with Cysview

This is a state-of-the-art drug/device technology used in the OR that helps providers better see non-muscle invasive bladder cancer (NMIBC) tumors when they look into the bladder. We are the first site to offer this technology in Washington. 

• BLC with Cysview uses a cystoscope equipped with both white and blue light. 
• Before the procedure, a small amount (less than 2 oz.) of the prescription imaging agent Cysview is placed into the bladder using a catheter. 
• Cysview makes the bladder cancer tumors glow pink in blue light, thus allowing providers to detect significantly more bladder cancer in patients (10-20 percent of bladder tumors are missed using traditional white light cystoscopy).
• BLC with Cysview supports a more complete resection, reducing recurrence rates by 20 percent and prolonging recurrence-free survival. 

Transurethral resection of a bladder tumor (TUR or TURBT)

This is the most common primary treatment for noninvasive bladder cancer, which sits on the inside surface of your bladder or within the first lining.

• The doctor inserts a thin camera (resectoscope) into your bladder through your urethra. 
• Then the doctor uses a special wire loop to remove (resect) as much of the tumor as can be done safely. 

Radical cystectomy

This surgery is used for cancer that has invaded your bladder muscle. 

• The surgeon removes your entire bladder and nearby lymph nodes to keep the cancer from spreading. 
• In men, the prostate is also removed.
• In women, the uterus, fallopian tubes, ovaries and part of the vagina may be removed. 

There are both open (through a larger incision) and laparoscopic (through small incisions) approaches to removing the bladder, and you might have either type of surgery.

Urinary reconstruction

To allow urine to exit your body after radical cystectomy, surgeons reconstruct a drainage system using portions of your intestines that have been separated from the rest of your intestines. There are three options:

• Ileal conduit/loop — The surgeon makes an opening (stoma) in your abdomen so urine can drain continuously into a pouch on the outside.
• Orthotopic neobladder — This involves constructing a new bladder that’s connected to your urethra so you can urinate as you did before. SCCA and UW Medicine surgeons pioneered techniques for creating a neobladder from a section of intestine. 
• Continent cutaneous urinary reservoir — This is a storage system that you drain every few hours using a catheter inserted through an opening in your abdomen.

Robot-assisted surgery for bladder cancer

SCCA and UW Medicine urologic surgeons perform laparoscopic radical cystectomy using robotic technology called the da Vinci Surgical System. We performed the first robot-assisted cystectomy in the region in both men and women, and we lead the area in providing this type of care.

• Your surgeon uses hand and foot controls to move robotic arms that hold a laparoscope (camera) and surgical instruments. 
• The system allows your surgeon to perform very precise, complex motions and helps prevent fatigue. 
• Robot-assisted surgery is associated with less blood loss, less pain and better cosmetic results with preserved cancer control.

Chemotherapy is the use of anti-cancer medicines to kill cancer cells. 

• It may be combined with surgery for localized bladder cancer and with surgery or radiation therapy for invasive disease. 
• It is the main treatment for cancer that cannot be cured with surgery or radiation because cancer has spread beyond the bladder.

Your SCCA team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout SCCA.

Intravesicular chemotherapy

After surgeons remove noninvasive cancer, they commonly place chemotherapy in the patient’s bladder to kill any cancer cells that remain there and to reduce the risk of cancer coming back. The medicine is put in through a urinary catheter, left for one to two hours and drained from your bladder before you leave the recovery room. 

Systemic chemotherapy

Systemic chemotherapy is given by infusion into a vein, and it travels throughout your body. It is typically given in three-week cycles, usually for four to six cycles. It can be used:

• Before or after surgery to improve the chances of a cure if your cancer has a high risk of spreading, including to destroy microscopic cancer cells might remain after surgery
• To make cancerous tissue easier to remove surgically if you have locally advanced disease that is too large for surgery
• To control your disease and symptoms and prolong your life if you have metastatic disease

Radiation therapy uses high-energy rays or subatomic particles to kill cancer cells. Systemic chemotherapy can be combined with radiation therapy (chemoradiation) to make the radiation more effective.

For bladder cancer, it’s especially important to receive radiation therapy from a center, like SCCA, that has extensive experience with this disease. In the 1980s now-retired SCCA physician Kenneth J. Russell, MD, was one of the early investigators pioneering the use of radiation therapy as a bladder-sparing treatment for localized muscle-invasive bladder cancer.

Your SCCA team may recommend radiation therapy:

• Along with chemotherapy, and in some cases surgery, if your cancer is invading the muscles of your bladder
• Along with chemotherapy if you cannot have or prefer not to have surgery
• As a way to relieve pain and prevent complications from cancer in your bladder or other places in your body if it has spread

Your radiation oncologist will customize the type, duration and dose of your treatments based on your particular situation and goals.

Immunotherapies are therapies that stimulate your immune system to attack cancer.

Two types of immunotherapy are used for noninvasive bladder cancer. In both cases, the treatment is given through a catheter directly into your bladder (intravesicular therapy).

• BCG therapy — The bacterium Bacillus calmette-guerin (BCG) is infused intermittently over weeks or months, stimulating your natural defenses to recognize and attack cancer cells. For precancerous lesions and for cancers that have not invaded the bladder muscle, this can provide effective control and prevent more advanced cancer.
• Interferon therapy — Interferons occur naturally in your body and can stimulate your immune cells to help eliminate cancer. Interferon therapy may be used alone or in combination with BCG if cancer persists or comes back despite BCG treatment.

Several immunotherapy medicines called immune checkpoint inhibitors are now approved by the U.S. Food and Drug Administration for bladder cancer that has spread. Your doctor may recommend one of these as part of your treatment based on the particular features of your cancer.