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 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 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.

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 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.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. You may be offered an immune checkpoint inhibitor for stage 2 or 3 bladder cancer that:

• is still growing during or after chemotherapy that includes the drug cisplatin
• comes back within 12 months of finishing chemotherapy
• can't be treated with surgery or chemotherapy
• has a high risk of coming back after surgery

An immune checkpoint inhibitor is most often used alone, but may be combined with chemotherapy. It can be used as a maintenance therapy after chemotherapy.

The immune checkpoint inhibitors used for bladder cancer target the PD-1 or PD-L1 checkpoint protein. The most common ones used are pembrolizumab (Keytruda) and nivolumab (Opdivo).

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.