Surgery or radiotherapy are the main treatments for invasive bladder cancer.

Surgery usually involves removing the bladder so you will pass urine differently from before.

Radiotherapy uses high-energy rays to destroy the cancer cells. It means that you will still have your bladder. Radiotherapy causes side effects and for some people the side effects may be long-term. If the cancer comes back after radiotherapy you may still need to have your bladder removed.

Your specialist may advise you which treatment is more suitable for you. For example, if you have a medical condition which makes the risks of surgery greater, then radiotherapy may be advised. If you have a larger tumour then surgery may sometimes be recommended.

Some people are offered a choice of having either surgery or radiotherapy. In some situations each treatment has the same chance of curing the cancer but also has its own benefits and disadvantages. Your specialist will talk this over with you so that you have enough information to decide which treatment is right for you.

Chemotherapy You may also be given chemotherapy (anti-cancer drugs) into a vein to shrink the tumour before your surgery or radiotherapy. This is called neo-adjuvant chemotherapy. It’s given to reduce the risk of your cancer coming back later on.

Some people are given chemotherapy at the same time as radiotherapy (chemoradiation). This is to make the radiotherapy more effective. 

Chemotherapy is also sometimes given after surgery to try and reduce the risk of the cancer coming back. This is called adjuvant chemotherapy. It’s usually given as part of a clinical trial because it’s not yet clear how helpful it is.

The benefits of treatment will vary depending on each person’s individual situation. In people with invasive bladder cancer, treatment is usually done with the aim of curing the cancer or controlling it for a long time.

Surgery (total cystectomy)

• Benefits:
• Does not involve radiation, so avoids the side effects of radiotherapy eg diarrhoea and cystitis
• There is no need for follow-up cystoscopies
• Disadvantages:
• Need 7–14 days in hospital for the operation and up to 3 months recovery time
• Needs an anaesthetic
• Need to wear a urostomy bag, learn to self-catheterise or learn to pass urine again
• Tiredness after the operation
• High risk of impotence in men and changes in sexual sensation in women
• Risk of death related to the surgery is about 2 in 100

Radiotherapy

• Benefits:
• Does not involve an operation
• No anaesthetic needed
• After treatment it is possible to pass urine normally
• Disadvantages:
• Need to attend the hospital each weekday for 4–7 weeks for treatment
• Tiredness during and after treatment (may last for some months)
• Diarrhoea may occur and cystitis is common during treatment (approximately 7 in 10)
• Possible long-term damage to the bladder and rectum (2–8 in every 100)
• Risk of impotence in men (up to 3 in 10)