Bladder cancer

Treatment for Bladder Cancer

All types and stages of bladder cancer and other urinary tract cancers are treatable. The key is to get care from experts who know the complex factors that go into choosing the right treatments for you at the right time — like the doctors at Fred Hutchinson Cancer Center.

Our bladder cancer specialists work closely with you, your family and each other to get you back to health. At Fred Hutch, we provide all standard therapies for bladder and other urothelial cancers and offer you access to the latest innovations through clinical trials. We treat even the rarest forms of bladder cancer. Our doctors are internationally known for their expertise and experience.
 

Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies.

Treatment Plan

Treatment for bladder and other urothelial cancers is highly customized for each patient’s needs.

How do we create your treatment plan?

Your Fred Hutch doctors work with an entire group that specializes in bladder cancer and other cancers of the urinary tract. They include urologic oncologists, medical oncologists, radiation oncologists, pathologists, radiologists and researchers who are all looking for better ways to treat this disease.

In our Bladder Cancer Multispecialty Clinic (BCMC), this team gathers every week in a meeting called a tumor board. Together, dozens of team members discuss their patients’ treatment plans. This approach means BCMC patients benefit from the experience of the whole group. 

With support from the larger team, your doctors will:

  • Talk about all possible treatments for your situation
  • Decide which therapies will be most promising for you
  • Check if any clinical trials match your needs, so you can think about joining them

Your care team will walk you and your caregiver through the treatment plan we recommend for you. You will have a chance to share your personal preferences, and you will decide together what happens next.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Why do treatment plans differ?

The treatment plan we design for you depends on many factors, including:

  • The type, stage and grade of your cancer
  • The size and location of your tumor
  • The molecular profile (make-up) of the cancer, which helps us tell if the cancer is likely to respond to certain therapies
  • Your age, overall health and other medical issues
  • Your needs, goals and preferences, like if you want to join a clinical trial that may be right for you
Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What is the standard therapy for bladder cancer?

Treatment for bladder cancer can be very different from person to person. However, the first treatment for non-muscle invasive cancer is usually surgery to remove the tumor, without removing the bladder. You may also have chemotherapy or immunotherapy in your bladder to reduce the risk of cancer coming back. 

For muscle-invasive cancer that has not spread to distant parts of the body, patients often have surgery to remove the bladder and make a new path for urine to leave the body. You may have chemotherapy before surgery. Some people can avoid bladder removal by having chemotherapy and radiation therapy

For metastatic cancer, the most common first treatment is chemotherapy. Other treatments, like immunotherapy, targeted therapy and other therapies, may help control the disease symptoms, shrink the tumor on imaging, slow down cancer growth, help you live longer and give you the best possible quality of life.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support as needed. These include integrative medicine, nutrition counseling, physical and occupational therapy, emotional support, genetic counseling to help you and your family with cancer prevention and care to reduce symptoms caused by the cancer or the treatments you receive.

Our patients can choose to receive promising, new bladder cancer therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Integrative medicine Combines conventional (standard) medical treatment with complementary and alternative (CAM) therapies that have been shown to be safe and to work. CAM therapies treat the mind, body and spirit. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

Treatment Process

We choose, combine and schedule your treatments based on what works for cancer like yours. Your care team makes sure you understand each type of treatment and all of your choices. 

You may get your care at the South Lake Union Clinic, UW Medical Center - Montlake or both. This depends on which treatments you need. If you need more than one type of treatment, we will coordinate your care. Our Bladder Cancer Multispecialty Clinic makes coordination easy.
 

Chemotherapy for bladder cancer

For localized muscle-invasive bladder cancer, you may have chemotherapy before or after surgery — or, in some cases, to try to save your bladder. If cancer has spread beyond your bladder, chemotherapy is the most common first treatment (and there are more treatment options). Your medical oncologist talks with you about the goals and the pros/cons of systemic therapy, prescribes it and sets your treatment schedule, based on the details of your cancer and your individual needs and wishes. 

Intravesicular Chemotherapy

After surgeons remove non-muscle invasive cancer, they often put chemotherapy into the patient’s bladder. The goals are to kill any cancer cells that are still there and reduce the risk of cancer coming back. The medicine is put in through a catheter. It is left for one to two hours. It is drained from your bladder before you leave the recovery room. 

Systemic Chemotherapy

Systemic chemotherapy is given by infusion (put into a vein). It travels throughout your body. 

It can be used:

  • Before or after surgery. This may improve the chance of a cure if your cancer has a high risk of spreading. It helps destroy microscopic cancer cells that might still be somewhere in the body after surgery and may not be visible on imaging.
  • To make cancer easier to remove with surgery. This may be helpful if you have large, locally advanced disease. 
  • To control the cancer and related symptoms, improve your quality of life and help you live longer if cancer has spread to distant parts of your body.

For an infusion, liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter), depending on the therapy. Treatment happens in repeating cycles.

You get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will also check on you during the treatment. They will handle any medical issues that come up and help keep you comfortable.
 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Infusion An injection of medications or fluids into a vein over a period of time. Infusion An injection of medications or fluids into a vein over a period of time. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Systemic therapy Treatment using substances that travel through the bloodstream, reaching and affecting cells all over the body.
Chemotherapy for bladder cancer

Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow). 

Surgery for bladder cancer

You may have chemotherapy either before or after surgery for muscle-invasive bladder cancer.

Blue-light cystoscopy with hexaminolevulinate HCl 

Our urologic oncologists use state-of-the-art technology to see non-muscle invasive bladder cancers more easily. It is called blue-light cystoscopy with hexaminolevulinate HCl. We are the first site in Washington to offer this technology.

In this approach, providers place a small amount of an imaging agent, hexaminolevulinate HCl, into the bladder. They do this through a catheter. Then, they put a cystoscope into the bladder through the urethra. The scope has both white and blue light. In the blue light, the imaging agent makes cancer cells glow pink. 

This allows us to find and remove more cases of bladder cancer. About 10–20 percent of bladder tumors are missed using the traditional white-light method.

Blue light also helps us get as many cancer cells as possible. Removing more cells lowers the risk that the disease will come back (recur). This approach reduces recurrence rates by 20 percent. It also helps patients live longer without recurrence.
 

Image of the pink glow to non-muscle-invasive cancer cells, helping providers recognize them.
Blue light cystoscopy (right) gives a pink glow to non-muscle invasive cancer cells. This makes then easier to see than with traditional white-light (left).

Transurethral resection of a bladder tumor (TUR or TURBT)

This is the most common first treatment for non-muscle invasive bladder cancer. Non-muscle invasive cancer sits on the inside surface of your bladder or within the first lining. The surgeon puts a thin camera (resectoscope) into your bladder through your urethra. Then, they use a special wire loop to remove as much of the tumor as they can get safely.

Radical cystectomy

This is surgery for cancer that has gone into your bladder muscle. The surgeon removes your entire bladder. They also remove nearby lymph nodes to keep the cancer from spreading further.  Other organs, like the prostate, uterus, fallopian tubes, ovaries or part of the vagina, may also be removed.

There are both open methods, which are done through a larger incision (cut), and robot-assisted methods, which are done through small incisions. Your care team will talk with you in advance about your exact procedure. 

Our urologic oncologists do many more of these surgeries each year than surgeons anywhere else in the state. This means your care team has a great deal of experience. Research clearly shows that higher-volume centers like ours have better outcomes. 

Some people with muscle-invasive cancer can avoid surgery to remove their bladder. Instead, they can have chemotherapy and radiation therapy. We also offer this bladder-sparing treatment in certain cases based on particular cancer features.

Urinary Reconstruction

To allow urine to leave your body after radical cystectomy, surgeons will make a new drainage system. They do this using parts of your intestines. There are three options:

  • Orthotopic neobladder — The surgeon makes a new bladder that is connected to your urethra. You can urinate the same as you did before. 
  • Ileal conduit/loop — The surgeon makes an opening (stoma) in your abdomen. Urine can drain all the time into a pouch outside your body.
  • Continent cutaneous urinary reservoir — This is a storage system that you drain every few hours. You do this using a catheter that goes through an opening in your abdomen.

Robot-Assisted Surgery 

Fred Hutch and UW Medicine urologic oncologists do laparoscopic radical cystectomy using robotic technology. We did the first robot-assisted cystectomy in the region, and we lead the area in providing this type of care.

With this system, your surgeon uses hand and foot controls to move robotic arms. These arms hold a laparoscope (camera) and surgical tools. The system lets your surgeon make precise, complex motions and helps keep them from getting tired. This method is linked with less blood loss, less pain and better cosmetic results with the same success in cancer control.
 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Cystoscopy Exam of the bladder and urethra with a cystoscope, inserted into the urethra. This thin, tube-like instrument has a light and lens and may have a tool to remove tissue to be checked for signs of disease.

Examination of the bladder and urethra using a cystoscope, inserted into the urethra. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Surgery for bladder cancer

Surgery is the main treatment for non-muscle invasive bladder cancer. It is also an important option for muscle-invasive bladder cancer. 

Radiation therapy for bladder cancer

Your Fred Hutch team may recommend radiation therapy:

  • With chemotherapy, if cancer has gone into your bladder muscle layer or if you cannot have or would rather not have surgery
  • As a way to relieve pain and prevent other problems from cancer 

A radiation oncologist decides on the type, dose, field and schedule of your treatment. 

For bladder cancer, it is important to receive radiation therapy from a center, like Fred Hutch, that has a great deal of experience with this disease. In the 1980s, now-retired Fred Hutch doctor Kenneth J. Russell, MD, was a pioneer in using radiation therapy for localized muscle-invasive bladder cancer. This allowed patients to keep their bladder instead of having it removed.
 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.
Radiation therapy for bladder cancer

Radiation therapy uses high-energy rays to kill cancer cells. It can be used with chemotherapy to make the radiation work better.

Immunotherapy for bladder cancer

For non-muscle invasive bladder cancer, doctors may use liquid therapies that are put into your bladder through a catheter (intravesicular therapies). In BCG therapy, a liquid carrying the bacterium bacillus Calmette-Guérin (BCG) is put into your bladder several times over weeks or months. BCG does not usually cause illness. It helps your body’s natural defenses to see cancer cells and fight them. For precancerous lesions and non-muscle invasive cancers, this may control the disease and prevent more advanced cancer. Other intravesicular therapies may include chemotherapy and new therapies available through clinical trials.

For bladder cancer that has spread, we have medicines called immune checkpoint inhibitors. A healthy immune system attacks bacteria, viruses and sometimes harmful cells, like cancer cells. It is supposed to leave harmless cells alone. One way that cancer cells survive is by sending false signals that make them look harmless. 

Immune checkpoint inhibitors block cancer’s false signals. This allows your natural defenses to work better. Your team may recommend one of these medicines based on the exact features of your cancer, your overall health and any other medical issues you have.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Precancerous A condition that may (or is likely to) become cancer. Also called premalignant.
Immunotherapy for bladder cancer

Immunotherapies, like BCG therapy, use the power of your immune system to find and fight cancer cells.

Targeted therapy for bladder cancer

Targeted therapies work in one of these ways:

  • They target a particular gene or protein that causes cancer growth.
  • They damage cancer cells directly based on a target in the cancer cells.

Like with chemotherapy, your medical oncologist will prescribe your targeted therapy. Some targeted therapies are a pill that you take at home. Others are given by infusion (put into a vein) in repeating cycles. 

Three targeted therapies for bladder cancer are erdafitinib (oral), enfortumab vedotin (infusion) and sacituzumab govitecan (infusion). The last two are targeted chemotherapies made of antibodies linked to drugs (antibody-drug conjugates). The antibodies deliver the drugs to certain cancer cells by finding and attaching to the cells. 

Other targeted therapies are being tested in clinical trials, and researchers are looking for more options. Your team may recommend this type of treatment if, for example, your bladder cancer gets worse after you have standard therapy or even as an initial therapy, depending on your case.
 

Antibody A protein made by immune system cells and released into the blood. Antibodies defend the body against foreign substances, such as bacteria. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Infusion An injection of medications or fluids into a vein over a period of time. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Targeted therapy for bladder cancer

For some bladder cancers, you may get targeted therapies. These are more exact than chemotherapy, which affects all fast-growing cells throughout the body.

Monitoring Your Health

While you are in active treatment, your bladder cancer care team will see you regularly for exams and tests to check:

  • How well your treatment is working, like if it is shrinking the cancer
  • If there is any reason to pause, stop or change your treatment
  • If you need help with side effects or supportive care services, like nutrition care, physical or occupational therapy, palliative care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how the cancer responds, how therapy affects you and what you prefer.
 

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What are the possible results of treatment?

Throughout treatment, your care team looks for signs of:

  • Remission: Fewer signs and symptoms of cancer or less cancer burden (smaller tumor) on imaging. Partial remission means some signs and symptoms remain. Complete remission means there are no signs or symptoms, including no cancer shown on imaging.
  • Stable disease: No change in the extent of cancer burden on imaging (or symptom severity). The cancer is not getting better, but it is not getting worse, either.  
  • Disease progression: The cancer is getting worse or spreading.
  • Relapse: The cancer signs or symptoms have come back, or cancer is again present on imaging, after they had improved.
  • Refractory disease: The cancer gets resistant to treatment.

What about “cured”? Sometimes doctors use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence could still be possible.
 

Disease progression When the disease is getting worse or spreading. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Refractory In medicine, refractory disease is a disease or condition that does not respond to treatment. Relapse The recurrence (return) of disease after an apparent recovery. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stable Cancer that is neither decreasing nor increasing in extent or severity. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Caregiver icon
Caregiving during treatment

If your loved one is having surgery, chemotherapy, radiation therapy, immunotherapy or targeted therapy, there are many ways you can help. Caregiving during active treatment often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms 
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning
Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

Supportive Care Services

Along with treating your bladder cancer, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need in a timely manner. 

If you would like to talk with other Fred Hutch patients and caregivers who have gone through bladder cancer treatment, please ask your care team. We can help connect you. 

Learn More

Managing Side Effects

You might be wondering about possible side effects from treatment. If you are, it may be helpful to know that the same doctors, nurses and advanced practice providers who treat your cancer are here to help prevent or relieve any side effects. You are always at the center of everything we do. 
 

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
How to get help with side effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects. Good communication is important.

In between and at your appointments, we want you to tell us right away about any side effects you may be having. If you have any questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours if that is when you need us (we are available 24/7).

We have many tools to help you feel better, such as:

  • The best supportive medications to prevent and treat symptoms, like nausea, indigestion and itching
  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Physical therapy to help you recover from surgery
  • Conventional and integrative therapies for pain

Learn More

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Steroid A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Common side effects of bladder cancer treatment

Side effects are different depending on which treatment you get. They also depend on other things, like how strong your immune system is. These are some of the common side effects of bladder cancer treatment: 

  • Unusual tiredness (fatigue)
  • Discomfort after surgery or changes in urination, like leakage or blockage
  • Hair loss
  • Problems in your digestive tract, like nausea, vomiting, diarrhea or constipation
  • Changes in appetite or taste
  • Skin problems, like rash, itching or dryness
  • Low blood cell counts, which can raise your risk for infection, easy bleeding and bruising, and fatigue
  • Changes in sexual feeling or function after bladder removal (radical cystectomy)

Other side effects may happen. Your doctors will talk with you to help you prepare and manage any side effects you may have.
 

Digestive tract The organs that food and liquids travel through when they are swallowed, digested and absorbed before leaving the body as feces. The organs that food and liquids travel through when they are swallowed, digested and absorbed before leaving the body as feces. These organs include the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum and anus. The digestive tract is part of the digestive system. Also called alimentary tract and gastrointestinal tract. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Continuing Care 

When your cancer is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your disease. They will check your overall health and look for signs that your cancer may have come back (signs of recurrence).

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over). 
 

Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.
Schedule for follow-up visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your doctors will base your schedule on many things, including: 

  • Your cancer type, stage and grade
  • Which treatments you had and how the cancer responded 
  • How the cancer and treatments affected you 
  • How long it has been since your treatment ended

Most patients have follow-up appointments for at least five years. It is common to have visits more often in the first months and years after active treatment ends and less often as time goes on. You and your doctors will talk about the best plan for you.
 

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What happens at follow-up visits

Follow-up for bladder cancer usually means seeing your team to talk about how you feel and to have a physical exam, blood and urine tests, cystoscopy (if you still have your bladder) and computed tomography (CT) scans. 

If there is any cause for concern, you might have other tests or scans. Together, you and your doctor will go over the benefits and risks of any follow-up options and decide what is right for you at the right time.
 

Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Cystoscopy Exam of the bladder and urethra with a cystoscope, inserted into the urethra. This thin, tube-like instrument has a light and lens and may have a tool to remove tissue to be checked for signs of disease.

Examination of the bladder and urethra using a cystoscope, inserted into the urethra. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.