Treatment for muscle invasive bladder cancer
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The MDT includes:
a urologist - a surgeon specialised in treating bladder problems
an oncologist – a cancer specialist
a radiologist – a doctor specialising in reporting and scans
a specialist urology nurse – also called a clinical nurse specialist (CNS)
a pathologist - a doctor who specialises in looking at cells under the microscope
Your team considers many factors, including:
where your cancer is
how far it has grown or spread (the stage)
the type of cancer
if the cancer has certain proteins or changes
whether you have any carcinoma in situ (CIS) in your bladder
how much urine your bladder can hold
what symptoms you have from your cancer
what cancer treatment you may have had before
your general health and level of fitness
how you feel about treatment and its side effects
Your doctor will talk to you about your treatment, its benefits and the possible side effects.
You might have one or more of the following treatments for muscle invasive bladder cancer:
surgery
chemotherapy
radiotherapy
radiotherapy with chemotherapy (chemoradiotherapy)
immunotherapy
targeted cancer drugs
If you have radiotherapy rather than surgery, you might hear your treatment described as ‘bladder sparing’ or ‘organ preserving’ treatment. This is because you still have your bladder at the end of treatment. It is different to surgery, where the surgeon removes your bladder.
You may also hear the term tri-modality therapy (TMT). This refers to the 3 different types of treatment that you often have if radiotherapy is your main treatment:
surgery – a TURBT operation to diagnose your cancer and remove as much as possible
radiotherapy – your main treatment
chemotherapy – you have this alongside the radiotherapy, to make it work better (chemoradiotherapy)
Most people start by having a trans urethral resection of bladder tumour (TURBT). This surgery diagnoses muscle invasive bladder cancer. And it finds out the stage of your cancer. You might have a second TURBT to make sure the surgeon has removed all the cancer.
Your doctor might then recommend surgery to remove your bladder (cystectomy). This is quite a big operation.
After a cystectomy, you need a new way of collecting urine. You might need to wear a bag to collect urine from an opening on your abdomen (urostomy). Or in some cases, your surgeon can create a new bladder.
Your surgeon will talk to you about ways to collect urine after the operation. They will tell you about the different operations, and what they involve. You might have a choice.
To reduce the risk of bladder cancer coming back, you might have other treatment before or after surgery. This is usually chemotherapy, immunotherapy or a combination of both.
Find out about surgery for muscle invasive bladder cancer
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The chemotherapy drugs circulate throughout the body in your bloodstream. This is different to having chemotherapy into your bladder for non muscle invasive bladder cancer.
You might have chemotherapy:
before surgery or radiotherapy - this is called neo adjuvant chemotherapy
alongside radiotherapy, to make the radiotherapy work better - this is called chemoradiotherapy
after surgery, if you didn’t have it before - this is called adjuvant chemotherapy
if your cancer has spread to other parts of the body (metastatic bladder cancer)
Read more about chemotherapy for bladder cancer
Radiotherapy uses radiation, usually x-rays, to destroy cancer cells. You might have radiotherapy with chemotherapy (chemoradiotherapy) as your main treatment. Or you might have radiotherapy to control symptoms if your cancer has spread.
Get more information on radiotherapy for bladder cancer
You usually have radiotherapy with chemotherapy. The chemotherapy helps the radiotherapy to work better.
You usually have the chemotherapy during the first and last week of radiotherapy. There are different drugs and different ways of giving them. Your doctor will tell you which chemotherapy drugs you will have and when.
Read about chemoradiotherapy for bladder cancer
Immunotherapy uses the immune system to fight cancer. It works by helping the immune system find and attack cancer cells.
You might have an immunotherapy drug called durvalumab with chemotherapy before surgery. You then have durvalumab on its own after surgery.
Or if you can't have chemotherapy, you might just have an immunotherapy drug called nivolumab after surgery.
For bladder cancer that can’t be removed with surgery (unresectable bladder cancer) or has spread to other parts of the body (metastatic bladder cancer), you might have immunotherapy drugs such as avelumab or atezolizumab. Or you might have pembrolizumab with a targeted cancer drug.
Get more information on immunotherapy for bladder cancer
Targeted cancer drugs work by targeting certain features of cancer cells that help them to survive and grow.
You might have a targeted cancer drug if your cancer can’t be removed with surgery. Or you have metastatic bladder cancer.
Targeted cancer drugs for bladder cancer include:
enfortumab vedotin - you have this with the immunotherapy drug pembrolizumab
erdafitinib, if your cancer has FGFR gene changes
Read about targeted cancer drugs for bladder cancer
In some cases, your doctor might offer you a choice of treatments. For example, your doctor might ask you to choose between:
surgery to remove your bladder or chemoradiotherapy
different ways of collecting urine after surgery if you are having surgery
But you might not have a choice if one or more of the treatments are not suitable for you. This depends on your situation. For example, they might not recommend radiotherapy if:
you have squamous cell bladder cancer
there is carcinoma in situ (CIS) in much of the bladder lining as well as invasive cancer
initial chemotherapy is not working
the cancer is blocking one or both of the tubes that carry urine into the bladder from the kidneys (ureters)
You may need to meet with one or more of the specialists in the team to discuss your options. Your specialist nurse will also help support you. You make the final decision about which treatment you have.
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
How to join a clinical trial for bladder cancer
You might feel you would like an opinion from a second doctor before deciding about your treatment. If so, you can ask your specialist doctor or your GP to refer you to another doctor specialising in bladder cancer.
There are advantages and disadvantages of getting a second opinion. It might help to think about why you would like a second opinion before you speak to your doctor.
Last reviewed: 24 Oct 2026
Next review due: 24 Oct 2029
The main type of bladder cancer is urothelial bladder cancer. The stage tells you about the size of the cancer and whether it has spread. The grade means how abnormal the cells look under the microscope.
Surgery is one of the main treatments for muscle invasive bladder cancer. The surgeon usually removes all your bladder (cystectomy) and makes a new way for you to pass urine. Doctors call this urinary diversion. Find out more about surgery for muscle invasive bladder cancer.
You might have radiotherapy instead of surgery as your main treatment for muscle invasive bladder cancer. Find out more about radiotherapy for muscle invasive bladder cancer.
For muscle invasive bladder cancer you have the drugs into a vein (intravenously). You might have chemotherapy before surgery or radiotherapy. This is called neoadjuvant chemotherapy. Or you might have it after surgery, this is called adjuvant chemotherapy.
Coping with bladder cancer can be difficult. There are things you can do to help, and people who can support you practically and emotionally.
Bladder cancer starts in the inner lining of the bladder. The bladder stores urine and is in the lower part of your tummy (abdomen).
