The treatment of transitional cell or urothelial carcinoma is different for superficial tumors and muscle invasive tumors. Superficial bladder cancers can be managed without cystectomy (removing the bladder), usually by transurethral resection (TUR) with or without adjuvant intravesical chemotherapy. Muscle invasive tumors require cystectomy. The distinction between superficial bladder cancer and muscle invasive bladder cancer is critical for treatment and can only be made by tissue diagnosis by a pathologist.

The Johns Hopkins Medical Institutions is a leader in the treatment of bladder cancer. Our surgeons have extensive experience in performing cystectomies, which is considered a major surgical procedure. Studies have shown that patients undergoing cancer procedures can significantly reduce their risk of operative death by selecting a high-volume hospital (one that does many procedures).

Treatment of Superficial Tumors   

The standard initial treatment of superficial tumors includes cystoscopy with trans-urethral resection of the tumor (TUR). A TUR does not involve making an incision in the body. The cystoscope, which is passed through the urethra into the bladder, allows visualization and entire removal of a bladder tumor. Some of these tumors will never recur and patients will be cured by the initial TUR.

Adjuvant intravesical drug therapy after TUR is commonly prescribed for patients with tumors that are large, multiple, high grade or superficially invasive. Intravesical therapy consists of drugs placed directly into the bladder through a urethral catheter, in an attempt to minimize the risk of tumor recurrence and progression. The most commonly used intravesical drugs are Bacille Calmette-Guerin (BCG) and Mitomycin C. Maintenance therapy (repeated therapy on a regular basis) with BCG or another drug administered intermittently following initial diagnosis and treatment of superficial bladder tumor decreases the likelihood of recurrence. About 50-68% of patients with superficial bladder cancer have a very good response to intravesical therapy.

Regular follow-up is required after a diagnosis of bladder cancer. Patients are generally seen by a urologist every 3 months for the first year or two, then every 6 months for a year or two, and once a year thereafter. At each visit, the urologist will perform cystoscopy with or without biopsy and obtain urine for urine cytology to test for cancer.

Treatment of Muscle Invasive Tumors   

A cystectomy is either partial or complete surgical removal of the bladder. Cystectomy is indicated when bladder cancer is invasive into the muscle wall of the bladder or when patients with superficial tumors have frequent recurrences that are not responsive to intravesical therapy. When the cancer has spread outside the bladder wall, cystectomy is not usually done. The benefits of surgically removing the bladder are disease control, eradication of symptoms associated with bladder cancer, and long-term survival. When the bladder is surgically removed, a replacement for the bladder needs to be constructed. The types of bladder reconstruction currently available for patients are ileal conduit, catheterizable pouch and neobladder. The urologist is best qualified to assess whether surgery is a possible option, and if a cystectomy is performed, which type of reconstruction is the best.

For advanced bladder cancer that has extended beyond the bladder wall, radiation and chemotherapy are treatment options. An oncologist plans the radiation therapy, which is executed in a way to kill cancer cells or alter their ability to multiply while the surrounding healthy cells are minimally affected. Local lymph nodes are frequently radiated as part of the therapy to treat the microscopic cancer cells which may have spread to the nodes. Current treatment of advanced bladder cancer can involve a combination of radiation and chemotherapy. The role of chemo-radiation therapy is to kill the bladder cancer cells both in and outside the bladder.