Bladder Cancer Treatment Approaches

Patients with all stages of bladder cancer will find the broadest array of treatment options at City of Hope. Many of our patients have been diagnosed with muscle-invasive bladder cancer and benefit from the advanced treatments and clinical trials available at City of Hope.

City of Hope has performed more robotic radical cystectomies and robotic cystoprostatectomies than any center in the world. 
Because City of Hope has specialists in all cancer-related fields in one location, patients receive greater continuity of care and more coordinated treatment planning. Our multidisciplinary team includes urologic oncological surgeons, medical oncologists and radiation oncologists who specialize in bladder cancer, working cooperatively to create the most effective treatment plan possible.
With bladder cancers, the selection of a surgical procedure depends on a cancer’s stage and grade.  For non-invasive bladder cancer – cancer that has not spread to the wall of the bladder – one of the following types of surgery may be done:
  • Transurethral resection (TUR) with fulguration:  Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or burn the tumor away with high-energy electricity. This is known as fulguration.
  • Radical cystectomy:  Surgery that removes the bladder and any lymph nodes and nearby organs that contain cancer. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed.  Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
  • Segmental cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
For invasive bladder cancer – cancer that has spread to the wall of the bladder – the following are surgical options:
  • Radical cystectomy:  The most common surgery for invasive bladder cancer is radical cystectomy. The doctor may also choose this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy involves the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes and part of the vagina are removed. Surgeons at City of Hope have performed more of these procedures than anyone in the world.
  • Urinary diversion:  Many patients today who require the removal of the entire bladder are candidates for continent urinary diversion, a type of surgery that creates a new way for the body to store and pass urine. It involves complete pelvic reconstruction that allows patients to recover normal urinary function.
  • Robotic Cystoprostatectomy: This novel urinary bladder reconstructive procedure has shown success in reducing blood loss and speeding recovery. Bladder cancer patients can resume normal physical activity and bladder control perhaps more quickly than ever.
City of Hope is one of the few institutions in the world performing minimally invasive robotic surgery on a routine basis. To perform the surgery, five or six small incisions (ports) are used, just as in laparoscopic radical prostatectomy.

An artificial bladder, known as the neobladder, is created by the surgeon using tissues from the intestines to create a new bladder that is very similar to a normal bladder. It is connected to the urethra, which enables patients to urinate normally, eliminating the need for an external bag and allows patients to transition back to their normal life after surgery.
In patients who are candidates for pelvic reconstruction, the new bladder can be reconnected to the urethra.  After the healing phase, those patients can urinate naturally (see urinary reconstruction). This portion of the operation is done completely laparoscopically and with greater precision.

Early results of this procedure indicate that blood loss is greatly reduced, and the overall physical recovery is far quicker; patients have a speedier return to normal physical activity and normal bladder control. Surgeons at City of Hope perform about 80 cystectomies per year, with 40 to 50 percent of patients receiving a neobladder, one of the highest proportion rates in the country.

Radiation Therapy

City of Hope offers the expertise of radiation oncologists who specialize in bladder cancer. Radiation is a form of energy that has long been used to treat many kinds of cancers.  In bladder cancer, radiation may be administered to relieve pain, in combination with chemotherapy or after surgery to minimize the risk of recurrence.

Treatments in which beams of energy are directed at the tumor from an outside source are referred to as external beam radiation.  At City of Hope, external beam radiation treatments may include:
  • Three-dimensional conformal therapy
  • Helical TomoTherapy
Considered the most advanced radiation therapy available, Helical TomoTherapy allows doctors to target and destroy cancer cells very precisely while sparing healthy tissues nearby. City of Hope was the first in the western U.S. to provide treatment for bladder cancer using this therapy.

City of Hope offers the expertise of medical oncologists who specialize in bladder cancer.  Chemotherapy drugs are administered either intravenously or orally. Chemotherapy may be combined with other treatments, and are often used to combat cancer that has spread beyond the bladder.
  • Intravesical Chemotherapy: Intravesical therapy is sometimes used for patients with early-stage bladder cancers. In this treatment, anti-cancer drugs are put into the bladder through a thin, flexible tube called a catheter. Drugs given this way reach cancer cells in the bladder lining without affecting cells elsewhere, which helps limit side effects.