What Are the Treatments for All Stages of Bladder Cancer?

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In 2017, more than 80,000 people were diagnosed with bladder cancer. Early symptoms can include blood in the urine that makes it appear pink or orange, pain with urination, and feeling urgency to urinate even when the bladder is not full. Treatment options vary by stage, as is common in most cancers. Here are the specifics per stage. But first, here's some insight into how you find out you have bladder cancer.

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How is bladder cancer diagnosed?

Urinalysis detects blood in the urine and can be the first step in diagnosing bladder cancer. If this test is positive, the doctor may choose to look closer at cells for tumor markers and abnormalities.

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Stage 0 treatment for bladder cancer: Tumor hasn’t spread

So you have bladder cancer. How is it treated in stage 0? For this stage, the tumor has not spread beyond the innermost layer and into the bladder wall. Treatment is often a transurethral resection (TURBT) where a rigid cystoscope is placed up the urethra and into the bladder to remove the abnormal tissue. Depending on the cancer’s grade, intravesical chemotherapy or intravesical Bacille-Camette Guerin (BCG), a form of immunotherapy, may be recommended.

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What is exactly is intravesical Bacillus Calmette-Guerin?

Intravesical means it is placed directly into the bladder. “BCG is what some would call the first immune therapy used in the treatment of cancer,” Arlene Siefker-Radtke, M.D., professor of genitourology at MD Anderson Cancer Center, says. “It was developed around the time of tuberculosis when they noted responses in patient’s bladder tumors due to BCG vaccines.” When used, BCG triggers the body’s immune system to fight cancer cells.

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When is BCG used?

“BCG is typically used for patients with high-risk superficial tumors that are more likely to recur,” Dr. Siefker-Radtke says, “with the goal of trying to control the tumor and keep it from spreading and invading so that patients can keep their bladders for longer.”

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Stage 1 treatment for bladder cancer: Tumor has spread into connective tissue

At this stage, tumors have grown into the connective tissue layer but not the muscle layer of the bladder wall. The first step in treatment for stage 1 bladder cancer is often surgery, called a transurethral resection of bladder tumor (TURBT), to determine the extent of the cancer. Then intravesical BCG immunotherapy or chemo is often given. If the cancer is high grade with extensive tumor growth, radiation or a cystectomy (removal of the bladder) may be recommended.

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Stage 2 treatment for bladder cancer: Tumors are on the move

These tumors have invaded the inner layer, the connective tissue, and the muscle wall of the bladder. TURBT is the first step in treatment for proper staging. Then a doctor performs a partial or radical cystectomy and nearby lymph nodes may also be removed. If cancer is growing elsewhere in the body, chemotherapy may be administered.

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Stage 3 bladder cancer has spread into nearly tissues, organs

In this stage, the cancer has spread outside the bladder and may be in nearby tissues and organs. A TURBT is usually done for staging and followed by chemotherapy, which is given to shrink the tumor before a radical cystectomy with node removal. Some patients may be given additional chemotherapy after surgery.

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Stage 4, or advanced bladder cancer, sees cancer spread throughout body

Stage 4 bladder cancer has spread beyond the bladder and reached lymph nodes, the pelvic wall, or other distant parts of the body. As these tumors have spread beyond the bladder, a radical cystectomy will not rid the body of cancer and is not often recommended as the first step of treatment. Instead, medical care is focused on slowing the growth and shrinking the cancer through chemotherapy, radiation, and/or immunotherapy.

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Post-treatment options for bladder cancer vary

If your cancer comes back, the new course of treatment will depend on extent and staging and may include any of the treatments previously listed – surgery, immunotherapy, chemotherapy and/or radiation. Approximately 70 percent to 80 percent of those with bladder cancer are diagnosed in the early stages. With proper treatment and care, you can lead a long and healthy life as a bladder cancer survivor.