Bladder cancer treatment depends on the type of cancer, its grade (how aggressive the tumor is) and its stage (the extent to which it has grown into the bladder or spread throughout the body), which is determined via a biopsy. Physicians describe bladder tumors as follows:
- Superficial tumors are confined to the lining of the bladder;
- Invasive tumors extend from the lining to the wall of the bladder, possibly to adjacent organs; and
- Metastatic tumors have spread beyond the bladder to distant parts of the body.
PRE-TREATMENT GUIDELINES
A physician will perform a biopsy to gauge the tumor’s severity and to decide on an appropriate course of treatment.
WHAT TO EXPECT
Treatment for bladder cancer includes:
- Tumor removal;
- Bladder removal;
- Intravesical therapy;
- Radiation; and
- Chemotherapy.
Superficial Tumors
For superficial tumors, treatment centers on removal of the tumor, with cystoscopic monitoring, or use of intravesical therapy.
Transurethral resection: Bladder tumors are removed using biopsy forceps, or through resection.
Cystoscopic monitoring: The physician regularly examines the lining of the bladder with a cystoscope, usually every 3 months.
Intravesical therapy. Chemotherapy, immunotherapy, or biological drugs are placed into the bladder.
Superficial bladder cancer treatment sometimes involves more extensive surgery.
Invasive Tumors
Surgical treatments. When a tumor extends beyond the surface lining of the bladder, cystectomy is often performed. In women, radical cystectomy commonly involves removal of the uterus, ovaries, Fallopian tubes, urethra, and part of the vagina. For men, the prostate and the seminal vesicles are removed.
When the bladder is surgically removed, the surgeon provides a new way for the patient to pass urine through various surgical procedures, including:
- Ostomy, or urostomy;
- Orthotopic urinary diversion; and
- Continent cutaneous urinary diversions.
Radiation therapy. High-energy rays are used to prevent cancer cells from growing and dividing. Radiation is directed specifically at the site of the cancer externally or internally. Radiation therapy may be performed before or after surgery, and it may be used in conjunction with chemotherapy.
Chemotherapy. Taken by mouth or injected, chemotherapy travels through the bloodstream to nearly all parts of the body.
Metastatic Tumors
If a tumor has spread from the bladder to distant parts of the body (metastases), chemotherapy can be an important treatment.
Palliative treatments, such as endoscopic resections or radiation therapy, can ease a patient’s symptoms.
Patients with metastatic bladder cancer can also participate in clinical trials.
SIDE EFFECTS AND POSSIBLE COMPLICATIONS
Transurethral resection. Side effects of transurethral resection include bleeding, temporary discomfort while urinating, and increased frequency of urination.
Cystectomy. Side effects include reduced volume of the bladder and decreased capacity to hold urine.
Radical cystectomy. Complications include:
- Blocked urine flow;
- Wound infections;
- Urine leaks; and
- Diminished sexual function and fertility.
Intravesical therapy. Side effects of intravesical chemotherapy may include:
- Irritation;
- Discomfort;
- Bleeding of the bladder;
- Bladder irritation;
- Low-grade fever with flu-like symptoms; and
- Infection.
Radiation therapy. Side effects of radiation therapy include:
- Darkening of the skin in the treated area;
- Tiredness;
- Nausea;
- Diarrhea;
- Urinary discomfort; and
- Possible decrease in white blood cells.
Systemic chemotherapy. Side effects of systemic chemotherapy include:
- Hair loss;
- Increased susceptibility to infections;
- Decreased energy;
- Poor appetite;
- Mouth sores;
- Nausea;
- Vomiting; and
- Kidney damage.
POST-TREATMENT GUIDELINES
Superficial tumors require cystoscope examinations every 3 to 6 months. Physicians may also recommend:
- Regular physical examinations;
- Urine tests;
- Imaging studies; and
- Blood tests.
