Bladder Cancer – Medications

Medicines may be used to control the growth of bladder cancer cells and to relieve symptoms. Chemotherapy uses medicines to destroy cancer cells. Immunotherapy uses medicine that causes your body’s immune response to attack cancer cells in your bladder.
Medication Choices

Chemotherapy may be taken by mouth (orally), injected into a vein (intravenous, or IV), or put into the bladder through a urinary catheter (intravesically). Chemotherapy can kill cancer cells both inside and outside the bladder area.
Medicines through a vein (IV)

* M-VAC is a combination of methotrexate, vinblastine, doxorubicin, and cisplatin. Methotrexate slows or stops the growth of cancer cells in the body and is frequently used in combination with other chemotherapy medicines. Cisplatin is a heavy metal that causes cell death by interfering with the multiplication of cancer cells.
* Gemcitabine is an antitumor medication that interferes with how cells divide and stops the growth of the cancer cells. It is often combined with another drug called cisplatin for treating bladder cancer.
* Doxorubicin is an anthracycline antibiotic medicine. Epirubicin and valrubicin are also anthracycline antibiotics that may be used.
* Paclitaxel or carboplatin are antitumor medicines that slow or stop the growth of cancer cells in the body.

Medicines through a catheter into the bladder

* Bacillus Calmette-Guerin (BCG) may stimulate an immune response or inflammation in the bladder wall to destroy cancer cells within the bladder. This is known as immunotherapy.
* Mitomycin is an antitumor antibiotic that interferes with the multiplication of cancer cells. When administered directly into the bladder, mitomycin may help prevent the recurrence of bladder cancer.

What To Think About

Medicines, alone or in combination, may be delivered directly into the bladder using a catheter (intravesically).

Adjuvant chemotherapy may be used with transurethral resection (TUR) of the bladder. Chemotherapy is also used when cancer cannot be controlled with surgery.

Most chemotherapy causes some side effects. Home treatment may be all that is needed to manage your symptoms. But some people may need medicines to control nausea and vomiting. If your doctor has given you instructions or medicines to treat your symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Clinical trials are research studies to look for ways to improve treatments for bladder cancer. Experts are doing studies on:

* Chemoprevention for early-stage bladder cancer. This is the use of medicines or vitamins to reduce the risk of getting cancer or having cancer come back.
* Photodynamic therapy. This uses medicine and a special light to treat the cancer.
* Chemotherapy before surgery. This is used for late-stage cancer.
* How to keep the bladder working while people get chemotherapy or radiation.

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Bladder Cancer – Prevention

Bladder cancer cannot be prevented, but you may be able to reduce some of your risk factors for developing it.

* Cigarette smokers are much more likely to develop bladder cancer than nonsmokers. For help on how to quit smoking, see the topic Quitting Smoking.
* Avoid exposure to industrial chemicals, such as benzene substances and arylamines. Occupational exposure from working with dyes, rubbers, textiles, paints, leathers, and chemicals increases the risk of developing bladder cancer.
* Avoid exposure to arsenic. Have your drinking water tested, and/or drink bottled water if you think that your water is contaminated with arsenic.
* Eat a healthy diet. Experts believe that what you eat and drink may help prevent bladder cancer.
o Eat a low-fat, low-cholesterol diet that includes plenty of fruits and vegetables. For more information, see the topic Weight Management.
o Avoid dehydration. Increase your fluid intake, particularly water. Water dilutes cancer-causing chemicals.

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.

Bladder Cancer – When To Call a Doctor

If you have been diagnosed with bladder cancer, be sure to follow your doctor’s instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Call your doctor if you:

* Have blood in your urine.
* Feel pain when you urinate.
* Are urinating small amounts frequently.
* Have back or flank pain.

Watchful Waiting

If you are concerned about your symptoms or you are concerned about your risk for bladder cancer, make an appointment with your doctor. Watchful waiting is not appropriate if you have symptoms that do not go away.
Who To See

Health professionals who can evaluate your symptoms and your risk for bladder cancer include:

* General practitioners.
* Family medicine doctors.
* Nurse practitioners.
* Physician assistants.
* Internists.
* Urologists.

Doctors who can manage your cancer treatment include:

* Urologists.
* Medical oncologists.
* Radiation oncologists.

Bladder Cancer – What Increases Your Risk

The major risk factors for bladder cancer include:

* Smoking.
o Cigarette smokers are twice as likely to develop bladder cancer as nonsmokers.1
o Pipe and cigar smokers have a slightly higher risk compared to nonsmokers, but the risk is significantly less than it is for cigarette smokers.
* Being older. Your risk goes up as you get older, and most people who get bladder cancer are close to their 70s.
* Being male. Men are 3 to 4 times more likely than women to develop bladder cancer.
* DNAchanges. These changes, which can be inherited or develop in your body on their own, can cause cells to grow too quickly or can keep cells from dying.
* Race. In the U.S., white people (Caucasians) develop bladder cancer twice as often as African Americans or Hispanics. Asians, Native Americans, and Alaska Natives have the lowest rates of bladder cancer.3
* Chemical exposure. Bladder cancer has been linked to chemicals called aromatic amines that are found in many products, including dyes, paints, solvents, inks, and the dust from leather. This risk may also depend on how much and how often a person was exposed to these chemicals.
* A history of treatment with cyclophosphamide or arsenic.
* A diet that is high in nitrates or rich in meat and fatty foods.
* Chronic bladder infections (cystitis), especially in people who have catheters in place all the time.
* A history of bladder cancer or a kidney transplant.
* A family history of bladder cancer.
* A history of radiation therapy or chemotherapy for treatment of endometrial or ovarian cancer.
* Schistosomiasis, which is an infection with the parasite Schistosoma haematobium. This condition is sometimes found in developing countries and rarely occurs in North America.

Bladder Cancer – Home Treatment

If you are receiving radiation therapy or chemotherapy to treat any stage of bladder cancer, you can use home treatment to help manage the side effects that may be caused by these treatments. Home treatment may be all that is needed to manage the common problems listed below. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

* Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Older adults can quickly become dehydrated from vomiting. Your doctor also may prescribe medicines for nausea and vomiting.
* Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea. Be sure to drink enough fluids.
* Home treatment for constipation includes ensuring that you drink enough fluids and eat fruits, vegetables, and fiber in your diet each day. Do not use a laxative without first talking to your doctor.

Other issues that may arise include:

* Sleep problems. If you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding caffeine late in the day.
* Fatigue. If you lack energy and become weak easily, try measures to help your fatigue, which include getting extra rest, eating a balanced diet, and reducing your stress.
* Hair loss. Hair loss may be unavoidable. But you can decrease irritation of your scalp by using mild shampoos and avoiding damaging hair products.
* Body image and sexuality problems. Sexuality problems can be caused by physical or psychological factors related to the cancer or its treatment. You may experience less sexual pleasure or lose your desire to be sexually intimate.
o Women who have the bladder removed (radical cystectomy) will also have the ovaries and uterus removed. They cannot become pregnant and may experience menopause soon after having the cystectomy.
o Men who have their prostate glands and seminal vesicles removed may have erection problems and will no longer produce semen.

Many people with bladder cancer face emotional issues as a result of their disease or its treatment.

* It is stressful to find out that you have cancer and to go through treatment. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Relaxation techniques, such as meditation, and support groups may be helpful.
* Your feelings about your body may change following treatment for cancer. Managing body image issues may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer support and information.

Bladder cancer rarely causes pain, and not all forms of cancer treatment cause pain. If pain occurs, many treatments are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain, such as a nonsteroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback, may improve your physical and mental well-being. Be sure to discuss with your doctor any home treatment you use for pain.

Some people with advanced-stage disease may choose not to have treatment 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.

Bladder Cancer – Symptoms

he most common symptoms of bladder cancer include:

* Blood or blood clots in the urine (hematuria). Hematuria occurs in 80% to 90% of people who have bladder cancer and is the most common symptom. Usually it is not painful.
* Pain during urination (dysuria).
* Urinating small amounts frequently.
* Frequent urinary tract infections (UTIs).

Symptoms that may indicate more advanced bladder cancer include:

* Pain in the lower back around the kidneys (flank pain).
* Swelling in the lower legs.
* A growth in the pelvis near the bladder (pelvic mass).

Other symptoms that may develop when bladder cancer has spread include:

* Weight loss.
* Bone pain or pain in the rectal, anal, or pelvic area.
* Anemia.

The symptoms of bladder cancer may be similar to symptoms of other bladder conditions.