Immuno-oncology treatment for Urothelial cancer


About urothelial cancer

If you have been diagnosed with urothelial cancer, or you know somebody who has, you’re probably collecting information about the disease and its treatments at every opportunity. This section of the KEYTRUDA website may help to answer some of your questions.

What is urothelial cancer?

Urothelial cancer, also called urothelial bladder cancer and transitional cell carcinoma (TCC), occurs when normal cells in the bladder turn into abnormal cells and start to replicate rapidly. It is the most common type of cancer affecting the bladder and urinary system (ureters, urethra and renal pelvis of the kidney).

As cancer cells multiply, they can spread to other areas of the body. When this happens, the disease is known as advanced urothelial cancer.

Your doctor or oncologist may have named the type of urothelial cancer you have based on how far it has progressed:

  • Non-invasive: This means the cancer is only in the inner layer of cells (the transitional epithelium); it has not grown into the deeper layers of the bladder wall.
  • Invasive: This means the cancer has grown into the deeper layers of the bladder wall and is more likely to spread to other areas of the body.
  • Advanced or metastatic: This means the cancer has spread from the bladder to other areas of the body.

What are the symptoms?

The symptoms of urothelial carcinoma may have included:

  • Blood in the urine (haematuria)
  • Frequent urination
  • Urgency to urinate, even when bladder is not full
  • Painful urination
  • A weak urine stream

With haematuria, urine may have appeared orange, pink or red. Sometimes urine may look normal, but blood is detectable with urinalysis. Blood may be present one day and gone the next. Sometimes urine can appear clear for weeks, but then return.

As urothelial cancer becomes more advanced, these symptoms may have occurred:

  • Being unable to urinate
  • Decreased appetite and weight loss
  • Feeling tired or weak
  • Swelling in the feet
  • Lower back pain, particularly on one side
  • Bone pain

How is it diagnosed?

When urothelial cancer is suspected, these tests are used for diagnosis:

  • Cystoscopy
    A thin flexible tube equipped with a light and a camera lens is inserted into the bladder via the urethra. The inner lining of the bladder is examined for abnormalities or unusual-looking tissue. Depending on what is discovered, a biopsy may be performed for laboratory analysis.
  • Computed Tomography Intravenous Urogram (CT IVU)
    This test involves injecting a special dye in the patient’s arm. The dye, which travels through the bloodstream, kidneys and urinary tract, enhances the visibility of the bladder and urinary tract. After the dye has circulated, a CT scan is used to obtain images that are used to diagnose abnormalities.

Treatment for urothelial cancer

  • Non-invasive stage
    • Tumour removal: Early stage urothelial cancer is most often treated with transurethral resection (TURBT), an endoscopic procedure that removes bladder tumours from the bladder wall.
    • Intravesical drug therapy: Tumour removal can be followed by observation (close follow-up without further treatment) or by intravesical drug therapy (inserted into the bladder via catheter) to prevent the cancer from coming back.
  • Invasive stage
    • Surgery: If the cancer has grown more deeply into the bladder wall, treatment usually involves removal of some or the entire bladder (a partial or full cystectomy). When the entire bladder is removed, an artificial bladder may be created internally (neobladder) or externally (urostomy bag). Some patients may not be considered suitable for surgery and alternative options may be discussed.
    • Radiation: Radiation therapy can be used as the main treatment in some cases. It may also be used after surgery to destroy any remaining cancer cells.
  • Advanced stage
    • Chemotherapy: For advanced urothelial cancer, combination chemotherapy using a cisplatin-based treatment is usually the first approach. A small percentage of patients with tumours in the nodes or lung may be cured with this type of chemotherapy. Cisplatin is a platinum-based medication that works by inhibiting or stopping cancer cell replication.
    • Immuno-oncology treatment: KEYTRUDA is an immuno-oncology treatment for advanced urothelial cancer. It may be used when bladder or urinary tract cancer has spread or can’t be removed by surgery, cisplatin-based chemotherapy is not suitable for a patient or cisplatin-based therapy didn’t work, or is no longer working.

Find out about getting KEYTRUDA for treatment of metastatic urothelial cancer

How KEYTRUDA works

Questions to ask your doctor about urothelial cancer

Before your next appointment, draw up a list of things you want to ask.


KEYTRUDA (pembrolizumab) 50mg powder for infusion
KEYTRUDA is a Prescription Only Medicine Use: KEYTRUDA is used in the treatment of melanoma which cannot be removed by surgery alone or when it has spread to multiple sites in the body. In the treatment of a kind of lung cancer called non-small cell lung cancer (NSCLC). In the treatment of classical Hodgkin Lymphoma (cHL). In the treatment of urothelial carcinoma, including bladder cancer. Side effects: Immune-mediated side effects including inflammation of the lungs, colon, liver, kidneys, pituitary gland, brain, eye, muscles, nervous system, pancreas, and heart, thyroid disorders, type 1 diabetes mellitus. Severe skin reactions including Steven-Johnson syndrome and toxic epidermal necrolysis. Severe infusion reactions including hypersensitivity and anaphylaxis. Transplant recipients: rejection of a transplanted organ, graft-versus- host-disease (in people with a bone marrow transplant using donor cells). Very common side effects include diarrhea, nausea, itching, rash, joint pain, back pain, feeling tired, cough, patches of discoloured skin, stomach pain, decreased levels of sodium in blood. Tiredness, nausea, vomiting, diarrhea, constipation, shortness of breath, rash, itching, headache, hair loss, and, infections of the upper respiratory tract were reported when given in combination with chemotherapy. You may experience more than one side effect at the same time. All medicines have risks and benefits. Talk to your doctor to see if KEYTRUDA is right for you. KEYTRUDA is a funded medicine for melanoma patients– restrictions apply. KEYTRUDA is an unfunded medicine for NSCLC, cHL and urothelial carcinoma patients. Ask your health professional the cost of the medicine and any other medical fees that may apply. Use only as directed and if symptoms continue or you have side effects, see your doctor, pharmacist, or health professional. Based on data sheet prepared 16 October 2017. Marketed by: Merck Sharp & Dohme (New Zealand) Limited, Newmarket, Auckland. For additional product information, consult the Consumer Medicine Information (CMI), available on request, phone 0800 500 673 or refer to the Medsafe website www.medsafe.govt.nz.

This site is intended for New Zealand residents.

References to support this are available on request.

MSD recommends people always seek the medical advice of their healthcare professional.

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