Table 7. Treatment Options for Bladder Cancer

Stage (TNM Staging Criteria) Treatment Options
Stage 0 Bladder Cancer TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy
TUR with fulguration
TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of BCG
TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by intravesical chemotherapy
Segmental cystectomy (rarely indicated)
Radical cystectomy (in rare, highly selected patients with extensive or refractory superficial high-grade tumors)
Stage I Bladder Cancer TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy
TUR with fulguration
TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of BCG
TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by intravesical chemotherapy
Segmental cystectomy (rarely indicated)
Radical cystectomy in selected patients with extensive or refractory superficial tumors
Stages II and III Bladder Cancer Radical cystectomy
Neoadjuvant combination chemotherapy followed by radical cystectomy
Radical cystectomy followed by adjuvant chemotherapy or immunotherapy
EBRT with or without concomitant chemotherapy
Segmental cystectomy (in selected patients)
TUR with fulguration (in selected patients)
Stage IV Bladder Cancer T4b, N0, M0 Enfortumab vedotin plus pembrolizumab
Chemotherapy plus immunotherapy
Chemotherapy alone
Systemic therapy followed by radical cystectomy
EBRT with or without concomitant chemotherapy
Urinary diversion or cystectomy for palliation
Any T, any N, M1 Enfortumab vedotin plus pembrolizumab
Chemotherapy plus immunotherapy
Chemotherapy alone or as an adjunct to local treatment
Immunotherapy
EBRT for palliation
Urinary diversion or cystectomy for palliation
Other chemotherapy agents with activity in metastatic bladder cancer, such as paclitaxel, docetaxel, ifosfamide, gallium nitrate, and pemetrexed (under clinical evaluation)
Clinical trials
Recurrent Bladder CancerCombination chemotherapy
Immunotherapy
Targeted therapy
Surgery for new superficial or localized tumors
Palliative therapy
Clinical trials

BCG = bacillus Calmette-Guérin; EBRT = external-beam radiation therapy; TNM = T, size of tumor and any spread of cancer into nearby tissue; N, spread of cancer to nearby lymph nodes; M, metastasis or spread of cancer to other parts of body; TUR = transurethral resection.

From: Bladder Cancer Treatment (PDQ®)

Cover of PDQ Cancer Information Summaries
PDQ Cancer Information Summaries [Internet].
Bethesda (MD): National Cancer Institute (US); 2002-.
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