Surgery is the most common treatment for bladder cancer. The type of surgery depends on the stage and grade of the tumor, and can include:
- Transurethral Resection (TUR) – TUR is often used to treat early bladder cancer. The doctor inserts a thin tube with a light called a cystoscope into the bladder. The doctor then uses a tool with a small wire loop to remove the cancer with an electric current and burn away remaining cancer cells. Some patients have chemotherapy or biological therapy after TUR.
- Radical Cystectomy – The doctor removes the entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that might contain cancer cells. In men, these may include the prostate, seminal vesicles and part of the vas deferens. In women, these may include the uterus, ovaries, fallopian tubes, and part of the vagina. Radical cystectomy is often used to treat invasive bladder cancer.
- Segmental Cystectomy – This treatment involves removal of part of the bladder. It is used when a patient has a low-grade cancer in just one area of the bladder wall.
Radiation therapy is used to destroy cancer cells that remain after surgery, to relieve pain caused by cancer, and occasionally to shrink tumors before surgery. Radiation can be given alone or with chemotherapy or surgery, or both. Radiation can be administered externally or internally. Some patients receive both external and internal radiation.
- External radiation – A large machine directs radiation at the abdomen and uses high-energy rays to kill cancer cells.
- Internal radiation – The doctor places a container of radioactive substance into the bladder through an incision in the abdomen. The patient may stay in the hospital for a few days.
Chemotherapy uses drugs to kill cancer cells, and may include one drug or a combination of drugs. Patients may have chemotherapy alone or with surgery, radiation, or both.
For patients with superficial bladder cancer, the doctor may use local therapy after TUR. This involves administering liquid drugs into the bladder using a catheter. The drugs remain in the bladder for several hours at a time. If the cancer is invasive or has spread, the doctor may give drugs through a vein. The drugs flow through the bloodstream to other parts of the body.
Immunotherapy uses the body’s immune system to fight cancer and is often used after TUR and helps prevent the cancer from returning.
Side Effect Management
The side effects of bladder cancer treatment vary according to the treatment. It helps to learn more about the side effects of your treatment(s) before you begin so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.
There are effective medications to address traditional side effects from cancer treatment, such as nausea, diarrhea, constipation and mouth sores. Newer targeted therapies tend to have fewer traditional side effects
Keep in mind that everyone reacts differently to treatment and experiences side effects differently. The most commonly reported symptoms associated with the following treatments are:
Radical Cystectomy – Bladder cancer surgery may affect the patient’s sexual function. After a radical cystectomy, women are unable to get pregnant and menopause occurs immediately. Sexual intercourse may be difficult. Some men are impotent after radical cystectomy.
Segmental Cystectomy – After segmental cystectomy, patients may need to urinate more often than before and may not be able to hold as much urine in their bladder. Often, this problem is temporary, but some patients may have long-lasting changes in how much urine they can hold.
Radiation therapy to the abdomen can cause nausea, vomiting, diarrhea, or urinary discomfort. Radiation treatment for bladder cancer can affect sexuality in both men and women. Women may experience vaginal dryness, and men may have difficulty with erections.
Side effects depend on the specific drugs and the dose and may include hair loss, loss of appetite, nausea and vomiting, diarrhea, fatigue, and mouth sores. Certain drugs used in the treatment of bladder cancer may cause kidney damage.
Side effects may include irritation of the bladder, an urgent need to urinate or frequent urination, pain when urinating, and fatigue. Some patients may have blood in the urine, nausea, a low-grade fever, or chills.