• Bladder Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Treat Bladder Cancer

    You can feel confident in the treatment at the Lank Center for Genitourinary Oncology at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), as our specialists focus exclusively on genitourinary cancers. If you need surgery, radiation, or chemotherapy, you will see experts in each area who deal specifically with bladder cancer. Because of this, bladder cancer patients from all across the nation seek treatment at DF/BWCC. Studies have shown that recovery and survival rates are higher for patients who are treated at a comprehensive medical center with a multidisciplinary team of experts, like those found at the Lank Center.

    For referring physicians

    Because the patient's primary care physician or community specialist is an integral part of the patient's care team, we are committed to collaborating in the care of your patient.

    If you are a physician and have a patient with bladder cancer, we look forward to working with you.

    Find out more about how to refer a patient to DF/BWCC.

    Find out about Physician Gateway, our portal that helps you keep track of patients you have referred for care. Physician Gateway is available for primary care providers, referring providers, and your authorized office staff.

    Multidisciplinary approach

    Our clinical and support teams are not just here to manage your cancer; they are here to care for you. We create a unique plan for every patient, and we consider all aspects of your health when making our recommendations.

    Our multidisciplinary team includes experienced urologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, physician assistants, and social workers who treat, counsel, and care for each patient with dedication and compassion. You have the advantage of meeting with your entire medical team in a single visit. Your team will also meet regularly to review your health and treatment options and ensure you receive the best possible care.

    Beginning with your first appointment, our nurses will walk you through the entire treatment process, making sure you know what to expect and where to find helpful resources, such as counseling, nutrition advice, or palliative care. In addition, each patient has a personal social worker to provide extra support and guidance.

    Bladder cancer treatment by stage

    Depending on how much the cancer has spread, you may have one treatment or a combination of treatments. Treatment largely depends on the stage and spread of the disease, but your overall health and age are always considered before treatment.

    • If you are diagnosed with stage 0 or stage I bladder cancer (superficial), your treatment will likely include immunotherapy to treat the inside of the bladder. Minimal surgery may be a part of your treatment plan as well. In rare cases, chemotherapy or radiation is recommended.
    • With stage II bladder cancer (muscle-invasive and localized), surgery is generally the first line of treatment. Radiation is also considered if the tumor has not spread or you cannot have surgery. Chemotherapy may be suggested in some cases.
    • If you are diagnosed with stage III bladder cancer (muscle-invasive and advanced), surgery and chemotherapy are the primary forms of treatment. Chemotherapy may be suggested before or after surgery, and radiation therapy is used on occasion.
    • Treatment for stage IV (metastatic) bladder cancer will generally consist of chemotherapy, clinical trials, or a combination the two. Surgery may be performed to remove the affected lymph nodes or relieve late-stage symptoms of the disease. Radiation therapy may also be introduced at this stage to ease pain and symptoms.

    Surgery

    Surgical approaches to the treatment of bladder cancer include:

    • Transurethral resection of the bladder tumor (TURBT): Uses special instruments attached to a cystoscope to cut the tumor and remove it with an electrical cautery device or laser.
    • Segmental cystectomy or partial cystectomy: Removes only the part of the bladder containing cancer cells.
    • Radical cystectomy for advanced bladder cancer: Removes the bladder, nearby lymph nodes, and organs that contain cancer cells. In men, radical cystectomy removes the bladder and seminal vesicles. In women, radical cystectomy removes the uterus, ovaries and part of the vagina.
    • Robotic radical cystectomy: Uses a combination of high-definition 3D magnification, robotic technology, and miniature instruments to enhance a urologic surgeon's skills when removing a cancerous bladder.
    • Incontinent diversion, also called urostomy: Creates a new opening for urination with a bag worn on the outside of your body to collect urine.
    • Continent urinary diversion: Creates a new bladder so you can control when urine leaves your body and you do not have to wear a bag.

    Chemotherapy

    Medical oncologists are doctors who study cancer tumors and deliver chemotherapy (drugs that eliminate cancer cells or stop them from dividing). Medical oncologists at DF/BWCC offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Medical oncologists and researchers at DF/BWCC are constantly testing and studying new combinations of chemotherapy drugs to improve outcomes, decrease side effects, and slow tumor growth or recurrence.

    Chemotherapy for bladder cancer may be given at any stage of the disease to control the tumor or ease the surgical process. Chemotherapy can be used before or after surgery, or in combination with radiation as a bladder-sparing treatment. It is also used in combination with surgery when the cancer has a high risk of spreading. However, chemotherapy is generally reserved for bladder cancer patients with muscle-invasive bladder cancer or advanced stages of the disease in which the cancer has spread to other parts of the body.

    Chemotherapy is provided at Dana-Farber's Yawkey Center for Cancer Care, one of the most advanced outpatient cancer centers in the country — designed by patients, for patients.

    Immunotherapy

    Immunotherapy is a type of treatment that uses the patient's immune system to fight cancer cells. Substances made by the body, or in a lab, may be used to boost, drive, or restore a patient's immune system defenses against cancer.

    Immunotherapy is usually suggested for early, superficial bladder cancers. The standard immunotherapy treatment for superficial cancer involves the bacteria Bacillus Calmette-Guerin (BCG). In these cases, cancerous cells are removed from the bladder wall, and the bladder is filled with a BCG solution. This solution produces an immune response that destroys cancer cells. BCG is an extremely effective agent for keeping the cancer from spreading or returning. The success rate for this type of immunotherapy is above 70 percent. In rare or advanced stages of bladder cancer, immunotherapy may be also recommended as a clinical trial.

    Clinical trials

    DF/BWCC offers one of the largest and most active clinical trial programs available, including clinical trials for patients with bladder cancer. We are passionate about discovering and offering novel trial opportunities that can't be found at any other comprehensive cancer center. We offer a wide range of clinical trials of new treatments for all stages of bladder cancer. The clinical trials conducted at DF/BWCC have had a profound impact on the type of care administered worldwide.

    For some patients with advanced bladder cancer, taking part in a clinical trial is the best treatment option. While there are opportunities for clinical trials at early and late stages of the disease, they are most often suggested for advanced stages of bladder cancer. However, our researchers are committed to creating trials for all stages of bladder cancer. We are especially dedicated to creating immunotherapy trial options and investigating targeted therapies. If you qualify for a clinical trial, your doctor will thoroughly review all options with you, and will recommend the best time to begin a trial (before, during, or after cancer treatment).

    Clinical trials are part of the cancer research process; they are safe and regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Not only can trials lead to new discoveries and improve cancer care, but they can also have life-saving benefits. Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer (immunotherapy or biotherapy). Trials also include targeted therapy or therapies using drugs to identify and attack the specific bladder cancer cells without harming healthy cells.

    Find out more about clinical trials at DF/BWCC.

    Detailed information about clinical trials is available from the NCI Web site.

    For nationally run clinical trials, please visit ClinicalTrials.gov.

    Questions to ask your doctor about clinical trials

    If your doctor suggests a clinical trial as part of your cancer treatment, you may have questions before you get started. Review some commonly asked questions about clinical trials and discuss them with your doctor.

    Radiation therapy

    Leading-edge techniques and the outstanding skill of DF/BWCC doctors allow for remarkable precision in the delivery of radiation treatment. Our radiation oncology team is highly skilled in treating unusual and complex cases. Team members have extensive experience treating recurrent bladder cancer with radiation therapy.

    Radiation may be used to treat certain bladder cancer patients, but it is not recommended for most patients, as bladder cancer often requires many radiation treatments. Radiation therapy is most common for stage II cases of bladder cancer where the cancer has invaded the muscle, but not spread. This type of therapy, in combination with chemotherapy, may be an alternative to surgery for certain patients. When appropriate, radiation may be used to relieve symptoms and improve quality of life.

    For patients who are good candidates for radiation, you can rest assured that doctors at DF/BWCC can target your tumor with extreme precision, and safely deliver high doses of radiation without damaging healthy cells. Our radiation oncologists deliver the most advanced radiation treatments for bladder cancer, including 3D imaging radiation therapy, also called intensity-modulated radiation therapy (IMRT). IMRT uses computer images to find and target the cancerous tumor, carefully firing thin beams of radiation at the tumor from different angles. This reduces the damage to the surrounding healthy tissue.

    Revolutionary imaging therapies

    All bladder cancer patients requiring radiation therapy will be cared for in an innovative operating and research environment developed at Brigham and Women's Hospital (BWH) in 2011. Called the Advanced Multimodality Image Guided Operating (AMIGO) Suite, our team of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses, and technologists use the latest imaging tools to develop and deliver the safest, state-of-the-art therapies. The AMIGO suite is unique, as it combines PET/CT, MRI and OR technologies in one operating room. BWH is one of the few hospitals in the United States to operate an AMIGO suite.

    Active surveillance

    Active surveillance (also known as "watchful waiting") is a crucial part of any treatment plan for bladder cancer patients. Bladder cancer tends to return, even if the cancer is an early-stage or non-invasive diagnosis. For that reason, many patients will go through initial treatment and then undergo careful monitoring by their doctors after treatment ends. Doctors will closely monitor the urinary tract without treating the patient, taking biopsies periodically or suggesting immunotherapy treatments to keep the cancer at bay. Active surveillance is always a part of any post-treatment plan.

    Next: Our Bladder Cancer Specialists 

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