Bladder Cancer Treatment Options

Transurethral Resection (TUR) is a minimally invasive surgery to remove non-muscle invasive cancer while preserving the bladder. The surgeon inserts a cystoscope and wire tools through the urethra to the bladder, so no incisions are made. Cancer is removed using electrical current or laser. Hackensack Meridian Health is one of only two centers in the state offering blue light cystoscopy, that makes non-muscle invasive bladder cancer glow bright pink, so the urologist can see any remaining cancer cells to be removed. Blue light cystoscopy is proven to reduce the chance of cancer progressing or returning.

• Bladder Sparing Surgery (Partial Cystectomy): Robotic or minimally invasive surgery to remove only part of the bladder, while saving some of your bladder and nerves necessary for bladder control.
• Bladder Removal (Radical Cystectomy): Robotic or minimally invasive surgery to remove the entire bladder, along with the prostate in men and the uterus and fallopian tubes in women. 

If the bladder needs to be removed, we often can build a new bladder. One of three methods may be used to provide a way for urine to exit your body.

• Ileal Conduit: A small segment of intestine is used to divert urine from the body through an opening next to the navel. This requires urine to be collected in an external device or bag.
• Neobladder Reconstruction: A segment of the small intestine is used to build a new bladder. This allows you to urinate normally without a bag or tube.
• Indiana Pouch: For patients who are not candidates for neobladder reconstruction but wish to avoid an external bag, an Indiana pouch is created with a small section of small intestine. Urine is collected inside the body. A small opening in the skin is made for a catheter to empty the reservoir.  

We offer unparalleled experience using intravesical therapy to treat non-muscle invasive bladder cancer and preserve your bladder. Intravesical therapy is a liquid drug delivered through a catheter directly into your bladder. It bathes the lining of the bladder to kill cancer cells or stimulate the body to fight the cancer. This prevents side effects that can occur with chemotherapy and other therapies that circulate throughout your body. Intravesical therapy includes:

• Bacillus Calmette Guerin (BCG): A form of immunotherapy that has proven effective for decades, BCG is inactive bacteria that prompts an immune response in the bladder. It is delivered in a series of six treatments.
• Intravesical Chemotherapy: For non-muscle invasive cancer, we may recommend intravesical chemotherapy following TUR to prevent cancer from returning. If cancer persists following BCG, you may be a candidate for a new intravesical therapy with anticancer drugs gemcitabine and docetaxel.

Hackensack Meridian Health is among the first in New Jersey to offer intravesical therapy for bladder cancers that, despite initial treatment, have continued to grow but are not muscle invasive. This approach may prevent up to half of patients with persistent, non-muscle invasive cancer from needing their bladder removed.

If your non-muscle invasive bladder cancer has been unresponsive to treatment, you may be a candidate for checkpoint inhibitor immunotherapy as an alternative to bladder removal surgery.

Immune checkpoints are a natural part of the immune system. However, cancer blocks immune checkpoints and causes the body to attack healthy cells.

Checkpoint inhibitors are designed to prevent that process and allow the immune system to be more active in attacking cancer cells. 

Chemotherapy uses medications to kill cancer cells. We offer the latest, most promising immunology approaches designed to treat your type of cancer. Our team of urologists works with medical oncology colleagues at the John Theurer Cancer Center to determine if systemic chemotherapy is appropriate for you. 

Depending on your stage of bladder cancer, your treatment plan may include:

• Chemotherapy as the first line of treatment. 
• Chemotherapy prior to surgery, to shrink your tumor or tumors.
• Chemotherapy following surgery, to kill any remaining cancer cells and prevent recurrence.
• Chemotherapy in combination with radiation therapy, as an alternative to surgically removing the bladder.

Advancements in radiation therapy now allow us to offer it in conjunction with chemotherapy as an alternative to surgically removing the bladder, for some patients who are candidates for this approach. 

Our radiation therapy specialists are among the region’s most experienced in using image-guided radiation therapy (IGRT), which employs images taken before each radiation therapy session to precisely focus treatment on the exact location of the cancer cells. IGRT allows for the most effective dose of radiation while minimizing side effects and protecting healthy bladder tissue.

Our team of Urologists works with radiation oncology colleagues at the John Theurer Cancer Center to determine if radiation therapy is appropriate for you. Your personalized bladder cancer treatment plan may include:

• Radiation therapy before surgery, to shrink your tumor or tumors.
• Radiation therapy following surgery, to kill any remaining cancer cells and prevent recurrence.
• Radiation therapy in combination with chemotherapy, as an alternative to surgically removing the bladder.
• Radiation therapy as palliative treatment if you are unable to have surgery, to help control symptoms of advanced bladder cancer.

The most common symptom of bladder cancer is blood in the urine (hematuria), which can make urine appear pink, red, or brown. Other potential symptoms include frequent or urgent urination, pain or a burning sensation during urination, difficulty urinating, and pain in the lower back or pelvis.

It's important to visit a urologist if you experience any of these symptoms, as they can also be caused by other conditions.

Some of the most common ways our urologists diagnose bladder cancer include:

• Cystoscopy: A primary method where a doctor inserts a thin, lighted tube with a camera (cystoscope) into the bladder to visually inspect it for abnormalities.
• Biopsy: If a tumor is found during cystoscopy, a small tissue sample is removed and examined by a pathologist to confirm the presence of cancer cells.
• Urine Cytology: A lab test where a urine sample is checked for cancer cells.
• Advanced Imaging: CT scans or MRIs may be used to see if the cancer has spread beyond the bladder.

The urologists at Hackensack Meridian Health offer a personalized, multidisciplinary approach to treating bladder cancer based on whether it's non-muscle invasive or muscle invasive.

• For Non-Muscle Invasive Cancer: Treatments often include a Transurethral Resection of a Bladder Tumor (TURBT) to remove the tumor, followed by intravesical therapy, where medication like BCG (Bacillus Calmette-Guerin) or chemotherapy is put directly into the bladder.
• For Muscle Invasive Cancer: More aggressive treatments may be required, such as a radical cystectomy (surgical removal of the bladder), often performed using robotic-assisted technology. This is frequently combined with chemotherapy, immunotherapy, or radiation therapy. The health system also offers advanced bladder reconstruction options, like a neobladder.

Learn more about all the treatment options we offer.