This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

There is a lot for you to think about when choosing the best way to treat or manage your cancer. There may be more than one treatment to choose from. You may feel that you need to make a decision quickly. But give yourself time to absorb the information you have learned. Talk to your doctor. Look at the list of questions in the section "What Are Some Questions I Can Ask My Doctor?" to get some ideas. Then add your own.

You may want to get a second opinion about the best treatment option for you. Doing so can give you more information and help you feel better about the treatment plan you choose. You will want to weigh the benefits of each treatment against side effects and risks.

The main types of treatment for bladder cancer are surgery, radiation therapy, immunotherapy, and chemotherapy. Surgery, alone or along with other treatments, is used in more than 9 out of 10 cases.

Surgery

There are several kinds of surgery for bladder cancer. Some involve removing the entire bladder and others do not. The type of surgery depends on the stage of the cancer. The most common types of surgery are explained below.

Transurethral surgery

This operation is used most often for early stage bladder cancer. It is done through a slender tube with a lens and a light that is placed into the bladder through the urethra. This tube is called a resectoscope. You will have either medicine to make the area numb or be put into a deep sleep (general anesthesia). With this approach there is no need to cut into the belly (abdomen). After surgery, other things may be done to get rid of any remaining cancer. These could be things like burning the base of the tumor through a cystoscope or treatment with a laser.

The side effects of this surgery are often mild and do not usually last long. There may be some bleeding or mild pain right after surgery. You can usually go home the same day or the next day. In less than 1 to 2 weeks you should be able to go back to your normal activities. If this surgery has to be done several times, long-term side effects may become a problem. There is a chance that the bladder can become scarred and not able to hold much urine. This means having to urinate often and the chance of losing urine (incontinence).

Cystectomy

When bladder cancer is invasive (the cancer has spread beyond the layer of cells where it started and into nearby tissues), all or part of the bladder may need to be removed. This operation is called a cystectomy. In this case the surgeon has to cut through the belly (abdomen) to get to the bladder. When only part of the bladder is removed, it is called a partial cystectomy. If the entire bladder is removed it is a radical cystectomy.

If the entire bladder is removed, nearby lymph nodes are also taken out. In men, the prostate is removed, too. In women, the womb (uterus), ovaries, fallopian tubes, and a small part of the vagina are often removed.

For either operation, you will be asleep. You will need to stay in the hospital for about 7 to 10 days. After about 4 to 6 weeks you should be able to go back to your normal activities. It is important that the surgeon doing this operation have experience in treating bladder cancer. If the surgery is not done well, the cancer is more likely to come back.

Side effects of this surgery could include a lot of bleeding, urinary infections, urine leakage, and blockage of urine flow.

Some doctors have strongly supported using transurethral resection surgery, along with radiation therapy and chemotherapy, for bladder cancer. Others do not agree, and feel that cystectomy is the best treatment for patients with early bladder cancer. This is something that you should discuss with your doctor.

Reconstructive surgery

If the whole bladder is removed, the body needs another way to store and remove urine. There are several ways to do this. These options can have a strong effect on how you feel about your body. You should talk to your doctors and nurses about any worries or concerns you might have when making these decisions.

One option is a urostomy. In this approach, tissue taken from the small intestine (bowel) is attached to the ureters and connected to the skin of your belly though a small opening (called a stoma). A bag sticks to your belly around this opening to catch the urine.

A second method is called a continent diversion. This does not require a bag outside the body. Instead, the surgeon creates a sac from a small piece of intestine and attaches the ureters to it. Urine is emptied when a drainage tube (catheter) is placed into the hole (stoma) of the diversion. You can find more information in the ACS document, Urostomy: A Guide. Newer methods of surgery can route the urine into the urethra, making urination nearly normal.

Some problems from these methods could include wound infections, urine leaks (incontinence), pouch stones, and blocked urine flow.

Bladder cancer surgery and sex

After radical bladder surgery, a man no longer makes semen. Sperm cells are still made but they do not exit the body and are reabsorbed. After this surgery a man will have a "dry" orgasm-- that is, there will not be any semen.

There may be some nerve damage after this surgery that causes many men to not be able to have an erection. Newer types of surgery may lower the chances of this problem, and it may also go away over time. As a rule, the younger a man is, the more likely he is to be able to have full erections. This is something men should talk to their doctors about before surgery.

It is normal for you to have concerns about your sex life after having a surgery for bladder cancer. With some simple planning, sex can be pleasurable and less stressful. Having a correct fit for your urostomy bag (if you have one) and emptying it before sex reduces the chances of a leak. You might wear a pouch cover or t-shirt during sex. To reduce rubbing against the bag, choose positions that keep your partner's weight off of it. For more information about dealing with sexual issues, please see the ACS document Sexuality for the Man with Cancer.

Intravesical therapy

Intravesical treatment is placed right into the bladder rather than being given by mouth or put into a vein. The most common form of this type of treatment for bladder cancer is immunotherapy. This treatment causes the body's own natural defenses (immune system) to attack the cancer.

BCG is an example of immunotherapy that is useful for treating low-stage bladder cancer. BCG is a type of bacteria that is sometimes used to vaccinate people against TB (tuberculosis). When used to treat bladder cancer, BCG is given right into the bladder through a thin, flexible tube called a catheter. The body's immune system responds to the BCG. Immune system cells are drawn to the bladder and attack the cancer. BCG is usually given once a week for 6 weeks.

BCG treatment may cause flu-like symptoms (mild fever, chills, and tiredness) as well as a burning feeling in the bladder. A high fever (over 101.5° F) that does not respond to aspirin or Tylenol® could mean a life-threatening spread of BCG throughout the body. If this happens, you should call your doctor right away. Usually these infections can be treated.

Another form of intravesical immunotherapy is interferon, a substance normally made by the body. Other drugs are often given with the interferon to relieve common side effects such as muscle aches, bone pain, headaches, tiredness, nausea, and vomiting.

Intravesical chemotherapy

In this treatment, anti-cancer drugs are put into the bladder through a thin, flexible tube called a catheter. Drugs given this way reach cancer cells in the bladder lining without affecting cells elsewhere. Because it mainly affects the cells lining the bladder, any cancer outside of the bladder lining is not treated. So, intravesical chemotherapy (chemo) is used only for early stage bladder cancers.

The main side effects of intravesical chemo are irritation and a burning feeling in the bladder.

Chemotherapy

Chemotherapy (often called simply "chemo") is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. Chemo is useful in treating cancer that has spread beyond the bladder to lymph nodes and other organs.

Chemo might be used to shrink a large tumor so it is easier to remove during surgery. When used this way it is called neoadjuvant chemo (giving the drugs before the local treatment). It can also be given after surgery to prevent the growth of stray cancer cells still in the body. This is called adjuvant chemo (giving the drugs after local treatment such as surgery or radiation). This can lower the chance that the cancer will come back later.

Sometimes chemo is given along with radiation in order to help the radiation work better. This can increase the side effects of radiation.

Side effects of chemo

While chemo drugs kill cancer cells, they also damage some normal cells and this can lead to side effects. These side effects depend on the type of drugs used, the amount taken, and the length of treatment. Short-term side effects might include:

• nausea and vomiting
• not feeling hungry
• hair loss
• mouth sores
• greater chance of infection (from a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
• tiredness (from low red blood cell counts, called anemia)

Most of these side effects go away when treatment is over. If you have any problems with side effects, be sure to tell your doctor or nurse, as there are often ways to help.

Chemo can cause long-lasting side effects such as early menopause and infertility. Older women treated with chemo have a higher chance of these side effects.

Radiation therapy

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells and shrink tumors. The radiation may come from outside the body or from radioactive materials placed directly in the tumor. After surgery, radiation can kill small deposits of cancer cells that may be too small to see.

After surgery, giving radiation therapy and chemo together can sometimes destroy cancers that would otherwise need to be treated by taking out the bladder (cystectomy).

Side effects of radiation

Side effects of radiation depend on the dose given and the place being treated. They tend to be worse if chemo is given with the radiation. Side effects may include:

• skin changes - ranging from redness to severe irritation with blistering
• nausea and vomiting
• bladder symptoms, like burning or pain with urination, feeling the need to go often, or blood in the urine
• diarrhea
• tiredness
• low blood counts

These problems usually go away after treatment ends. If you have these or other side effects, you should talk to your doctor. Often there are ways to help.

Bladder cancer survival by stage

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is found. Of course, many people live much longer than 5 years. Five-year relative survival rates assume that people will die of other causes, too. They compare the survival of people with bladder cancer to that expected for people without bladder cancer. This gives a better picture of the deaths from bladder cancer.

The numbers below come from the National Cancer Institute, SEER Data Base. They are based on patients diagnosed from 1988 to 2001.

These numbers provide an overall picture, but keep in mind that every person's situation is unique and the statistics can't predict exactly what will happen in your case. Talk with your doctors if you have questions about your personal chances of a cure, or how long you might survive your cancer. They know your situation best.

If bladder cancer comes back

When a cancer comes back after treatment, it is called recurrent. Recurrence can be local (in or near the place it started) or distant (spread to organs such as the lungs or bone).The outlook for recovery and the type of treatment for recurrent bladder cancer depends on the place and size of the cancer and what kind of treatment was used the first time.

Last Medical Review: 02/11/2009
Last Revised: 05/06/2009