Our Treatment Approach
You can feel confident in the treatment at the Lank Center for Genitourinary Oncology at Dana-Farber Brigham Cancer Center, 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 Dana-Farber Brigham Cancer Center. 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.
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.
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.
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.
Medical oncologists are doctors who study cancer tumors and deliver chemotherapy (drugs that eliminate cancer cells or stop them from dividing). Medical oncologists at Dana-Farber Brigham Cancer Center offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Medical oncologists and researchers at Dana-Farber Brigham Cancer Center 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 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.