Bladder Cancer – Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for people who have bladder cancer depends on the stage and grade of cancer. Your doctor also considers your age, overall health, and quality of life when developing your treatment plan.

Bladder cancer is usually curable if it is diagnosed while the cancer is still contained in the bladder, and about 74% of bladder cancers are diagnosed at this early stage.2

Treatment choices for bladder cancer may include:

* Surgery to remove the cancer. Surgery, either alone or in combination with radiation therapy, chemotherapy, or biological therapy, is used more than 90% of the time to treat bladder cancer.5
* Chemotherapy to destroy cancer cells using medicines. Chemotherapy may be given before or after surgery.
* Radiation therapy to destroy cancer cells using high-dose X-rays or other high-energy rays. Radiation therapy may also be given before or after surgery and may be given at the same time as chemotherapy.
* Immunotherapy. This therapy causes your body’s natural defenses, known as your immune system, to attack bladder cancer cells.

Initial treatment

Surgery is used to treat most stages of bladder cancer.

* Small bladder tumors that remain near the surface (superficial) may be burned with a low-voltage electrified probe (electrocautery) during a cystoscopy.
* Transurethral resection (TUR) is used to remove large early-stage bladder tumors or tumors that penetrate more deeply into the tissue but have not spread outside the bladder.
* Surgical removal of the bladder (cystectomy) is usually done for the most advanced stages of cancer that is confined to the bladder. Cystectomy may also be done for high-grade bladder cancers or when there are multiple tumors in the bladder. Surgery may not be recommended for an older adult who has a long-term medical condition.

Chemotherapy uses medicines to destroy cancer cells. For early-stage bladder cancer, the medicines may be delivered directly into the bladder using a catheter (intravesically). For cancer that has deeply invaded the bladder or spread to lymph nodes or other organs, chemotherapy may be given orally or intravenously (IV). Side effects may differ, depending on the medicines used and your age and overall health. For some people, depending on the stage of the cancer, chemotherapy given before cystectomy (neoadjuvant) leads to better results.6

Radiation therapy, which uses high-dose X-rays or other high-energy rays to destroy cancer cells, is not used very often to treat bladder cancer. It may be used when there is only a single small tumor, or when a person cannot have surgery. Radiation therapy also is used as palliative care to relieve symptoms and preserve kidney function. Home treatment can help manage some of the side effects of radiation therapy.

Immunotherapy uses medicines that cause your body’s immune system to attack bladder cancer cells. Bacillus Calmette-Guerin (BCG) and interferon are two of the medicines used for immunotherapy. Immunotherapy is most often used for early-stage bladder cancer. It may be used after a transurethral resection (TUR) to prevent cancer recurrence.
Home treatment measures may help relieve some common side effects of cancer treatment, such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.

If you have recently been diagnosed with bladder cancer, you may feel a wide variety of emotions in reaction to your diagnosis. Most people feel some denial, anger, and grief. There is no “normal” or “right” way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reaction after learning that you have bladder cancer. Some people find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.
What to think about during initial treatment

Your quality of life becomes a critical issue when considering your treatment options. Be sure to discuss your personal preferences with your urologist and oncologist when they recommend treatment.

Some people with bladder cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. People who do not want standard treatments or who are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of North America and in some other countries for people with all stages of bladder cancer.

When bladder cancer is found early, before it has spread outside the bladder, more than 90% of people live at least 5 years after they are diagnosed. The long-term outcome (prognosis) for men older than 65, African Americans, and those who smoke is worse than for other people who have bladder cancer.

Treatment for advanced-stage bladder cancer is intended to control symptoms and increase comfort (palliative care), not cure the disease.

For more information about specific bladder cancer treatments, see the topics:

* Bladder Cancer – Health Professional Information [NCI PDQ]
* Bladder Cancer – Patient Information [NCI PDQ]

Ongoing treatment

After initial treatment for bladder cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment, depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Your urologist or oncologist will schedule regular checkups based on the stage and grade of your tumor. These checkups usually include:

* A cystoscopy and urine test every 3 to 6 months during the first and second years after your initial treatment.
* A cystoscopy and urine test every 6 months during the third and fourth years after your initial treatment.
* Yearly exams after the fourth year.
People with high-grade tumors of any stage may also have an intravenous pyelogram (IVP) or computed tomography (CT urogram) done every year.
Treatment if the condition gets worse

Bladder cancer can come back (recur) in the bladder or spread (metastasize) to other parts of the body. Recurrent bladder cancer may be treated with surgery or chemotherapy to slow cancer growth and relieve symptoms.

Participation in a clinical trial may be recommended if you have been diagnosed with recurrent bladder cancer.
Complementary therapies

In addition to conventional medical treatment, some people may want to try complementary therapies, such as:

* Acupuncture.
* Dietary supplements.
* Biofeedback.
* Meditation.
* Yoga.
* Visualization.

Complementary therapies are not a substitute for the standard treatment recommended for bladder cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.
What To Think About

Most treatments for bladder cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

* Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss. There is also an increased chance of getting a serious infection during chemotherapy treatment. Mitomycin may cause skin peeling or a rash.
* Side effects of surgery depend on how extensive your surgery was to treat the stage of your cancer. Men may have erection problems after surgery if the bladder is removed (cystectomy). If you choose a surgeon who performs many of these procedures, you will have fewer side effects and you will recover faster.
* Side effects of radiation may include nausea, vomiting, diarrhea, pain or discomfort when urinating, and bladder inflammation and scarring (radiation cystitis). You may also have an increased risk of infection.
* Side effects of immunotherapy vary depending on the medicine. Bacillus Calmette-Guerin (BCG) is a tuberculosis vaccine used in countries outside the United States. With BCG, the side effects may include fever, joint pain, inflammation of the prostate, or disseminated tuberculosis.

Home treatment measures may help you manage the side effects.
Palliative care

If your cancer gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life, not just in your body but also in your mind and spirit. Some people combine palliative care with curative care.
Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term illness, make future plans around your medical care, or help your family better understand your illness and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.
End-of-life issues

Some people with advanced-stage disease may choose not to have treatment focused on prolonging life because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about stopping medical treatment to prolong life and shifting the focus to end-of-life care can be difficult. For more information, see the topics:

* Hospice Care.
* Care at the End of Life.

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