Bladder Cancer medications & treatments

In the U.S., bladder cancer is the 4th most common cancer in males and the 8th in females. According to the American Cancer Society, over 81,000 new cases of bladder cancer will occur in 2022 (about 61,700 in men and 19,480 in women). They also estimate that over 17,000 people will die from this disease. Caucasians are twice as likely to develop bladder cancer than African Americans or Hispanic Americans.

What is bladder cancer?

The bladder is a hollow, balloon-shaped organ in the lower part of your abdomen. It stores urine made by your kidneys until it is released out of the body through the urethra. Bladder cancer typically begins in the urothelial cells that make up the inner lining of the bladder wall.

There are 3 main types of bladder cancer:

• Urothelial carcinoma. Over 90% of all bladder cancers are urothelial carcinoma (UCC) or transitional cell carcinoma. This type can be low-grade or high-grade. Low-grade UCC often recurs (returns) after treatment, but rarely spreads to the muscle layer of the bladder or other parts of the body. High-grade UCC often returns after treatment. It typically spreads to the muscle layer of the bladder and other parts of the body such as lymph nodes. Most bladder cancer deaths are due to high-grade UCC.
• Squamous cell carcinoma. This cancer forms in the thin, flat cells (squamous cells) that line the inside of your bladder. It may develop after chronic infection or irritation.

• Adenocarcinoma. This very rare type of bladder cancer develops in glandular cells, which are found in the lining of your bladder.

Bladder cancer causes

The following risk factors may increase your chance of developing bladder cancer:

• Smoking. If you smoke tobacco, you are 4 to 7 times more likely to develop bladder cancer than non-smokers.
• Age. Your risk of bladder cancer increases with age. More than 90% of bladder cancer cases occur after age 55.
• Gender. Males are up to 4 times as likely to develop bladder cancer than females.
• Personal and family history. If you have had bladder cancer before, you are at a high risk of developing it again. Your risk also increases if someone in your family (parents or siblings) has a history of bladder cancer.
• Race. Caucasians are twice as likely to develop bladder cancer than African Americans or Hispanic Americans.
• Chemical exposure. Exposure to arsenic and certain chemicals used to manufacture textile, rubber, leather, dye, and paint can increase your risk.
• Chemotherapy or radiation treatment. If you have taken the chemotherapy drug cyclophosphamide or had radiation to your pelvis, you are at an increased risk of bladder cancer.
• Chronic bladder issues. Chronic urinary tract infections (UTIs), kidney or bladder stones, and long-term use of a catheter all increase your risk of bladder cancer.

How is bladder cancer diagnosed?

To properly diagnose bladder cancer, your doctor or healthcare professional will look at your symptoms, review your medical history, perform a physical exam, and run some tests.

Bladder cancer symptoms

The most common symptoms and signs of bladder cancer are shared by other medical conditions. These include:

• Blood in the urine (most common symptom)
• Frequent urination
• Painful urination
• Lower back pain
• Feeling the need to urinate but not being able to
• Unintentional weight loss

There is no definitive screening test for bladder cancer. Your doctor may perform the following to help diagnose your bladder cancer:

• Urinalysis. Examining your urine for the presence of blood and cancer cells (urine cytology) can help find some bladder cancers during their early stage. It is not typically used as a routine screening tool.
• Cystoscopy. This is performed by a urologist using a thin, lighted tube with a lens or video camera (cystoscope) to examine the inside of your bladder and urethra for signs of disease. Your doctor may remove a tissue sample for a biopsy.
• Biopsy. If abnormal areas are seen during a cystoscopy, your doctor may want to get a tissue sample for a biopsy. Transurethral resection of bladder tumor (TURBT) or transurethral resection (TUR) is the procedure your doctor will perform to remove the abnormal area and test it for cancer cells.
• Imaging tests. Your doctor will use imaging tests such as a computed tomography scan (CT scan), MRI scan, ultrasound, or x-ray to examine your bladder and other structures of your urinary tract. You may be injected with a dye before these procedures to help your doctor see any abnormalities.

What are some bladder cancer treatment options?

Surgery

• Transurethral resection of bladder tumor (TURBT). Also called transurethral resection (TUR), this procedure is typically performed if abnormal areas are seen during a cystoscopy. It involves using a thin, rigid instrument called a resectoscope that is inserted into your bladder through your urethra. It has a wire loop at the end that’s used to remove any tumors and have them sent to a lab for testing. TURBt may be the only treatment you need if you have non-muscle-invasive bladder cancer.
• Radical cystectomy. This procedure is used to remove the bladder and any nearby lymph nodes or organs that are affected. In men, their prostate and seminal vesicles will also be removed. In women, their ovaries, uterus, and a small part of the vagina will also be removed. You will typically stay in the hospital for a week after this surgery and will return to your normal activities in a couple of weeks.
• Partial cystectomy. If the cancer has invaded the bladder wall but is limited to one part of the bladder, your doctor may remove the tumor without having to take the whole bladder. Your nearby lymph nodes may also be removed and tested for cancer.
• Urinary diversion. This surgery is typically done after a radical cystectomy makes a new way for the body to store and pass urine.

Radiation therapy

Radiation therapy uses high-energy x-rays or other particles to destroy cancer cells or stop them from growing. This is typically performed by a radiation oncologist. It is often used as a primary treatment if surgery is not an option or you cannot take chemotherapy.

Immunotherapy

Immunotherapy medications are given as system therapy (goes into the bloodstream) or intravesical therapy (given directly into the bladder). Tice BCG (Bacillus Calmette-Guerin) is a commonly used intravesical immunotherapy to treat early-stage bladder cancer. BCG helps your immune system recognize and attack bladder cancer cells.

Some systemic options include immune checkpoint inhibitors such as Keytruda (pembrolizumab), Opdivo (nivolumab), and Tacentriq (atezolizumab).

Chemotherapy

Chemo drugs can also be used systemically or given directly into the bladder. Intravesical chemotherapy drugs such as Mutamycin (mitomycin) and Gemzar (gemcitabine) are given directly to the bladder. They are usually given if BCG cannot be used or has failed.

Some chemo drugs that are commonly given systemically include Platinol AQ (cisplatin), Taxol (paclitaxel), and Taxotere (docetaxel). A combination of chemo drugs is usually combined to treat bladder cancer.

Targeted therapy

Medications such as Balversa (erdafitinib) and Trodelvy (sacituzumab govitecan) target proteins, genes, and other factors specific to your cancer to stop its growth. Your doctor may run tests to identify these specific factors to help determine the most effective treatment. Targeted therapy typically causes less damage to healthy tissue than chemotherapy or radiation.

What is the best medication for bladder cancer?

The best medication for the treatment of bladder cancer will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with bladder cancer medications, and the individual’s potential response to the treatment plan. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter bladder cancer medications approved by the Food and Drug Administration (FDA).

Best medications for bladder cancer

Best-medicationsfor bladder cancer

Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of bladder cancer medications?

As with all medicines, those used for bladder cancer will have some side effects, depending on the class you are taking:

• Chemotherapy medications can cause you to have low white blood cell counts which increases your risk of infections. Some other common side effects include nausea, vomiting, hair loss, anemia, fatigue, muscle pain, headache, and joint pain.
• Immunotherapy drugs can commonly cause joint and muscle pain, fatigue, rash, diarrhea, cough, nausea, vomiting, constipation, and itching.
• Targeted therapy medications can cause fatigue, nausea, joint and muscle pain, diarrhea, headache, high blood sugar, and decreased levels of electrolytes.
• Intravesical medications such as Mutamycin (mitomycin) commonly causes increased urinary frequency and urgency, bladder pain, incontinence, and urinary tract infections.

What are some home remedies for bladder cancer?

There are no home remedies or natural ways to treat lung cancer. Medications, surgery, and radiation are the treatments you will need to treat this condition. After completing treatment, it’s very important to go to all of your follow-up appointments.

There are some lifestyle changes and self-care measures you can take to reduce your risk of bladder cancer, including:

• Stop smoking. Smoking increases your chance of developing bladder cancer.
• Maintain a healthy weight. Research has shown that you have an increased risk of non-invasive bladder cancer if you are overweight or obese.
• Stay hydrated. Drinking plenty of fluids may decrease your risk of bladder cancer. It empties your bladder more often, which may help your kidneys get rid of any harmful chemicals.
• Avoid harmful chemicals and dyes.
• Contact your doctor if you have any signs and symptoms of bladder cancer such as blood in your urine, pain when you urinate, and back pain with no known cause. 

Frequently asked questions about bladder cancer

Who is at risk for bladder cancer?

Smoking is the biggest risk factor for developing bladder cancer. Some other risk factors include family and personal history, age, gender, race, exposure to certain chemicals, and chronic bladder infections.

What are some signs and symptoms of bladder cancer?

While they can be due to a different condition, some common signs and symptoms include blood in your urine (hematuria), painful urination, feeling like you need to urinate and can’t, and back pain.

Can bladder cancer be cured?

If diagnosed and treated early, you have a higher chance of it being cured. However, after treatment, you are at a high risk of it returning.

What is the survival rate for bladder cancer?

For localized and early-stage cases of bladder cancer, the 5-year survival rate is 70% to 96%. For cases that have spread, it drops to 6%.

How do I take part in a clinical trial for bladder cancer?

Cancer research for new treatments is always ongoing. Check with the National Cancer Institute for information regarding clinical trials you may be eligible to participate in.

Related resources for bladder cancer

• What is the bladder? Centers for Disease Control and Prevention
• What is bladder cancer? American Cancer Society
• Bladder cancer symptoms and causes. MayoClinic
• Bladder cancer treatment. National Cancer Institute
• What is bladder cancer? WebMD
• Bladder Cancer. StatPearls – National Library of Medicine
• Bladder cancer. Medscape