Bladder Cancer – Treatment for Stage II

Stage II cancers have invaded the muscle layer of the bladder wall. Transurethral resection (TURBT) is typically the first treatment for these cancers, and to define the extent of cancer.

When the cancer has invaded the muscle, radical cystectomy (removal of the bladder) is the standard treatment. Lymph nodes near the bladder often have to be removed. A small number of patients with tumor in only one part of bladder can be treated with a partial cystectomy. This is a very small portion of patients.

At this stage the cancer has not been detected outside the bladder, but tiny deposits of cancer could have been growing elsewhere in the body. Therefore chemotherapy is necessary. The chemo before surgery is called neoadjuvant chemo, the one after surgery is called adjuvant chemo, the purpose of which is to lower the chance of recurrence.

Many doctors prefer neoadjuvant chemo, which is to give chemo before surgery, because statistics show neoadjuvant helps patients live longer than surgery alone. But there’s a risk of doing so in some cases. Chemo before surgery means surgery has to delay. This is not a problem if the chemo shrinks the bladder cancer, but it is harmful if the tumor continues to grow during chemo.

Some patients may prefer to keep their bladder, they would prefer to choose a second and extensive transurethral resection (TURBT), followed by chemo and radiation. So far it’s not clear if the outcomes are as good as they are after cystectomy. Patients under this treatment need frequent and careful follow-up exams. Some experts recommend a repeat cystoscopy and biopsy during treatment with chemo and radiation. If cancer is found in the biopsy sample, a cystectomy will likely be needed.

There’re a few patients who have serious health problem and can’t take a major operation, in such cases a combination of TURBT, chemo and radiation might be the treatment option.


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