Carolinas HealthCare System

What kind of treatment a patient receives for bladder cancer depends on how aggressive the cancer is, or what stage it's reached. Levine Cancer Institute physicians have years of experience and expertise in selecting the appropriate treatment regimen for bladder cancer. Typically, there are four avenues of treatment: surgery, radiation therapy, immunotherapy and chemotherapy. Here's what you need to know about each.


Surgery for bladder cancer may involve removing cancerous cells while leaving the bladder intact, or removing the bladder entirely. There are many different forms of surgery, including:

  • Transurethral bladder tumor resection (TURBT). A thin, lighted tube known as a cystoscope is inserted into the bladder, where a small wire loop removes the cancer. This is also used in diagnosing bladder cancer.
  • Radical cystectomy. The bladder is removed, as are any affected lymph nodes and organs (for example, the prostate, uterus, ovaries and part of the vagina).
  • Segmental cystectomy. Only part of the bladder is removed, particularly if the tumor is considered "low-grade," or confined to one section of the bladder.
  • Urinary diversion. When the bladder is removed, this surgery is performed to create a new way for the body to store and pass urine.

Depending on the cancer, chemotherapy may be given before surgery to kill off any microscopic cancer cells outside the bladder. In this case, a chemotherapy regimen called MVAC (methotrexate, vinblastine, adriamycin and cisplatin) may be used. The two-drug combination gemcitabine and cisplatin is another option.

Radiation therapy

High-dose X-rays or other types of radioactive substances kill cancer cells or prevent them from growing. Radiation may be delivered via a machine that targets cancer—called external radiation therapy—or through vessels (for example, seeds, wires or catheters) that place the radioactive substances directly inside or near the tumor. For some patients, radiation may be all that's needed. Radiation therapy can also be used to control pain in cancer that has spread.


BCG anti-cancer medication therapy triggers a reaction that revs up your own immune system, killing cancer cells in the bladder. Typically, this treatment is used for high-risk tumors and is continued for up to three years after to maintain effectiveness.


Chemotherapy is a family of drugs used to stop cancer-cell growth. It can be given via mouth or injection, and may target cancer cells throughout the body (systemic chemotherapy) or specific areas (regional chemotherapy). It can also be given through a tube inserted directly into the bladder (known as intravesical chemotherapy). Drugs used to treat bladder cancer include mitomycin C, which may be used after TURBT to prevent a recurrence of cancer in low-risk patients, as well as some high-risk patients and patients who have not responded to bacillus Calmette-Guerin (BCG) therapy.

Clinical trials

Sometimes an effective treatment has yet to come to the market. Levine Cancer Institute has a strong focus on clinical trial research and encourages the patients to take part.