Bladder cancer treatment options depend mainly on the stage of the cancer when it’s first found. The stage tells how deep the tumour has grown in the bladder wall and whether it has spread outside the bladder. Doctors use this information to recommend the best bladder cancer therapy.

Other things like how big the tumour is, how fast the cancer cells grow (called the grade), and how many tumours there are also are important. These things help doctors decide the risk level and the most effective treatment. Apart from this, the patient’s physical health, past health history, lifestyle, and personal choices also impact the available bladder cancer options.

Treating Early-Stage Bladder Cancer (Stage 0 and Stage I)

Stage 0 and Stage I bladder cancers haven’t grown into the bladder’s muscle layer yet. They include:

• Stage 0a: A papillary tumour that hasn’t invaded
• Stage 0is: A flat tumour (carcinoma in situ)
• Stage I: Tumor that has grown into the layer under the bladder lining but not into muscle

Bladder cancer treatment options for these early stages usually begin with surgery, called TURBT (transurethral resection of bladder tumour). The doctor might also burn the area with electricity (fulguration) and give chemotherapy to the bladder within a day. They may also recommend immunotherapy depending on the patient’s condition. Immunotherapy treatment for bladder cancer can help prevent recurrence and improve the immune system’s ability to fight cancer.

Low-Risk Cancers

These are small, low-grade tumours. Usually, no more treatment is needed. The doctor checks the bladder with a scope (cystoscopy) every few months. If no new tumours are found, the time between checks can be longer.

Intermediate-Risk Cancers

These tumours might be larger, high-grade, or come back after treatment. Usually, treatment is chemo or BCG (a type of bladder treatment) given inside the bladder once a week for 6 weeks. Sometimes, this is followed by more treatments for up to a year.

High-Risk Cancers

These high-grade cancers may be flat (CIS) or have grown deeper (T1). Another TURBT might be done to ensure the cancer hasn’t reached the muscle.

• Continued immunotherapy for several weeks and months
• Surgery to remove the bladder (radical cystectomy)

Follow-Up

After early-stage cancer treatment, the bladder needs to be checked often. Low-risk cancers usually have a good outcome. Higher-risk cancers may come back and become more serious.

StageII  Bladder Cancer Treatment Options

This stage means the cancer has reached the muscle layer but hasn’t gone beyond it. A TURBT is done first to check the stage. Then, treatment could include:

• Chemo, followed by bladder removal (radical cystectomy)
• Chemo and Immunotherapy, surgery, and more rounds of immunotherapy
• Immunotherapy spares the load on the body that chemo usually has
• Bladder-sparing treatment like immunotherapy, chemo with radiation, if surgery isn’t an option
• If lymph nodes have cancer, immunotherapy, radiation or more chemo may follow surgery

If the bladder isn’t removed, regular checks with cystoscopy and biopsy are needed. If cancer remains, surgery may still be needed.

Treating Stage-III Bladder Cancer

This means the cancer has reached tissues or organs near the bladder or nearby lymph nodes. Like stage II, treatment starts with a TURBT. Treatment options:

• Chemotherapy and immunotherapy, then surgery and more immunotherapy
• Radiation with immunotherapy or radiation with chemo for people who can’t have surgery
• Rounds of immunotherapy for those who can’t get chemo

If cancer is found in lymph nodes after surgery, more immunotherapy chemo-radiation might be needed. If cancer stays or comes back, bladder removal may be needed.

Treating Stage IV Bladder Cancer

This stage means the cancer has spread far into the body. It’s very hard to cure.

If the cancer hasn’t spread far from the bladder (M0):

Treatments may include:

• Immunotherapy
• Chemo
• Chemo followed by immunotherapy
• Radiation with chemo

After a few rounds of treatment, doctors check to see if the cancer has shrunk. If it has, surgery or more treatment might be done.

If cancer has spread far (M1):

Treatment is usually intensive rounds of immunotherapy, chemotherapy. If the cancer gets smaller, surgery or radiation might be an option. Other drugs or clinical trials may be considered, if treatments stop working,

If Cancer Comes Back or Grows

If cancer comes back in the bladder, it may be treated the same way as before. The bladder may need to be removed if the cancer keeps on coming back. If cancer spreads far, surgery usually isn’t possible. Chemo, immunotherapy, radiation, or other drugs might be used instead. When standard treatments stop working, clinical trials or supportive care may help ease symptoms and improve quality of life. Always tell your care team if you have any symptoms—they may be able to help.

Supportive and Complementary Treatments for Bladder Cancer

Supportive and complementary therapies are those which:

1. Help in mitigating the side effects of conventional cancer treatments like chemotherapy and radiotherapy.
2. Improve the quality of life of cancer patients both during and after other cancer treatments.
3. Improve the immune power of cancer patients, enabling them to fight against other diseases.

Complementary cancer treatments don’t affect ongoing cancer treatment. Instead, it supports it so that the treatment may benefit the patient more. Bladder Cancer Treatment options all depend on the stage, the grade of tumour, the prognosis of disease and the health of the patients.