Treatments for stage 2 and stage 3 bladder cancer

The following are treatment options for stage 2 and stage 3 bladder cancer.

Before any treatment starts, your healthcare team will suggest treatments based on your needs and work with you to develop the best treatment plan. Most often the whole bladder needs to be removed. But sometimes it may be possible to keep the bladder, which is called a bladder-preserving approach. The order you receive treatments depends on if you are offered a bladder-preserving approach or not.

Chemotherapy

Chemotherapy is almost always offered for stage 2 and stage 3 bladder cancer. It is often given before radical cystectomy surgery, but it can be given after surgery if it wasn’t already used. Chemotherapy may also be used alone if surgery can’t be done.

Chemotherapy is given as a systemic therapy through a needle into a vein. A combination of chemotherapy drugs that includes cisplatin is standard treatment for stage 2 and stage 3 bladder cancer.

If you are being treated with a bladder-preserving approach, chemotherapy is most often used as a part of chemoradiation. It may include cisplatin or 5-fluorouracil (Adrucil, 5-FU) with mitomycin (Mutamycin). Chemoradiation is given after a transurethral resection of bladder tumour (TURBT) so the bladder doesn’t have to be removed.

Surgery

Surgery is a main treatment for stage 2 and stage 3 bladder cancer. In most cases, at least one of the following surgeries is done.

A cystectomy removes all or part of the bladder. A radical cystectomy to remove the whole bladder is most commonly done. Once the bladder is removed, urinary diversion surgery is needed to make a new way to hold urine (pee) and pass it out of the body.

A pelvic lymph node dissection (PLND) removes lymph nodes from the pelvis. It is done following a radical cystectomy, usually during the same surgery.

A transurethral resection of bladder tumour (TURBT) removes tumours from the bladder through the urethra. It may be done if you are being treated with a bladder-preserving approach. A TURBT is usually done during diagnosis. But another TURBT may be needed to make sure all the cancer is removed, especially if it has been a long time since the first TURBT.

Radiation therapy

You may be offered external radiation therapy for stage 2 or stage 3 bladder cancer. It may be given as a part of chemoradiation after a TURBT. External radiation therapy may also be used alone if surgery can’t be done.

Targeted therapy

Targeted therapy is sometimes used to treat locally advanced bladder cancer. Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer and limit harm to normal cells. Erdafitinib (Balversa) can be used to treat locally advanced bladder cancer that has mutations in the FGFR2 or FGFR3 gene and doesn't respond to chemotherapy.

Clinical trials

Talk to your doctor about clinical trials open to people with bladder cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • Alberta Health Services . Muscle Invasive and Locally Advanced/Metastatic Bladder Cancer Clinical Practice Guideline GU-002 (Version 5) . Alberta Health Services ; 2013 : https://www.albertahealthservices.ca/.
  • American Cancer Society . Treating Bladder Cancer . 2016 : https://www.cancer.org/.
  • American Society of Clinical Oncology . Bladder Cancer . 2017 : https://www.cancer.net/.
  • Cancer Care Ontario . Bladder Cancer Diagnosis, Treatment and Follow-up Care Pathway Map (Version 2017.02) . 2017 : https://www.cancercareontario.ca/en.
  • Chang SS, Bochner BH, Chou R, et al . Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline . Journal of Urology . 2017 .
  • Feldman AS, Efstathiou JA, Lee RJ, Dahl DM, Michaelson MD, Zietman AL . Cancer of the bladder, ureter, and renal pelvis. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 65:896-916.
  • Finelli A, Brown J, Flood T, Kulkarni G, Hotte S, O’Malley M and the Genitourinary Cancer Advisory Committee, Cancer Care Ontario. Cancer Care Ontario Bladder Cancer Guideline 3-21: An Endorsement of the 2017 American Urological Association Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer - AUA, ASCO, ASTRO, SUO Guideline. 2018.
  • National Cancer Institute . Bladder Cancer Treatment (PDQ®) Health Professional Version . 2018 : https://www.cancer.gov/.
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer (Version 5.2018).
  • Penn Medicine . All About Bladder Cancer . University of Pennsylvania ; 2017 : https://www.oncolink.org/.