Bladder Cancer: Treatment Options

How is it treated?

Treatment options for Bladder Cancer (like all cancers) vary with the stage of development that the disease is in. Some form of surgery is often part of the treatment. This can be as simple as the removal of a small area of the bladder lining or as extreme as removing the entire bladder and some surrounding organs. Early detection is the key factor that determines what type of treatment is necessary. Treatment options are different for each individual case, but there are several common procedures listed below. The information presented is intended to provide patients with treatment information that they can use in discussing treatment options with their physician.

Surgery for Bladder Cancer

Surgery is often followed by radiation or chemotherapy to destroy cancer cells that may have spread or may have been missed during surgery.

• Transurethral resection (TUR): A cytoscope, a slender tube with a lens and a light, is inserted through the urethra and into the bladder. Cancerous tissue can be removed with a thin wire at the end of the tube or can be burned off using an electric current. In this surgical treatment, no incision is made into the abdomen. The procedure is normally done in the hospital and requires anesthesia.
  
  
• Cystectomy: An incision is made in the abdomen and part or all of the bladder is removed. This procedure is normally done when the cancer has spread to deeper layers of the bladder tissue. The two common types of cystectomies are:
  
  
  • Partial Cystectomy is when only part of the bladder is removed. Normal urinary function is usually possible following surgery.
    
    
  • Radical Cystectomy is when the entire bladder is removed along with some surrounding organs and tissue. This procedure is normally performed when the cancer has spread to surrounding areas. In males the prostate and seminal vesicles are removed as well as the bladder. In females the uterus, ovaries, and part of the vagina are removed as well as the bladder.
    

When the entire bladder is removed, an alternate method of urine removal is necessary. A urostomy is a procedure in which tissue from the small intestine is attached to the ureters and then attached to a bag worn externally. The patient periodically empties this bag. A second procedure is known as a continent diversion. This is when the doctor creates a sac inside the body that connects to the kidneys. The patient places a drainage tube into the diversion hole to periodically drain urine. Some newer surgical techniques can actually make it possible to have normal urination after a radical cystectomy but this procedure is not always a possibility.

Other Treatments

• Radiation Therapy - In some cases X-rays can be used to kill or shrink cancer cells at the site of the tumor. The radiation may be administered by a machine, such as a linear accelerator or cobalt apparatus, or from a radioactive source implanted within the diseased area. External beam radiation therapy uses radiation from outside the body to focus on the cancer and is, therefore, not the primary treatment for cancer that may have spread.
  
  
• Chemotherapy- Drugs are administered by mouth or injection to kill the cancer cells. The drugs enter the blood stream and can therefore reach areas of the body where the cancer may have spread.
  
  
• Immunotherapy - A liquid substance, BCG, is placed in the bladder to stimulate the activity of the immune system, which is the body's natural means of defense. The solution remains in the bladder for 2 hours and then is removed by urination. This is typically done once a week for 6 weeks.
  
  
• Clinical Trials- There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.
  

What are the side effects of the treatments?

Certain side effects have been associated with different types of treatments. Each patient's response to treatment will be different but there are some common effects.

Possible Side Effects from Surgical Treatment

• TUR - There temporarily may be some urine in the blood and general discomfort from the procedure. These side effects normally go away after a few days, leaving no permanent side effects.
  
  
• Partial Cystectomy - Some pain or discomfort flows surgery, but can be controlled with medication. The urine capacity of the bladder may be decreased immediately after surgery, but usually it will eventually return to full capacity.
  
  
• Radical Cystectomy - This type of surgery has more extensive side effects than the other surgical options. There can be complications associated with the urostomy or continental diversion procedures that allow for urination after bladder removal. Wound infection is always a possibility and there is the inconvenience of emptying the bag or sac. Males are no longer able to father children and sometimes experience impotence after surgery. Females are no longer able to bear children because the uterus is removed during surgery. Also, the removal of part of the vagina can make sexual intercourse difficult.
  

Possible Side Effects from Non-Surgical Treatments

*Most side effects are temporary and can often be relieved with medication.

• Radiation Therapy
  
  • Nausea, vomiting, diarrhea
    
  • Sexual dysfunction
    
  • Irritation to the skin near the radiation site
    
• Immunotherapy
  
  • Nausea and tiredness
    
  • Discomfort while urinating
    
• Chemotherapy
  
  • Nausea and vomiting -Loss of appetite
    
  • Loss of hair
    
  • Mouth sores
    
  • Increased susceptibility to infection
    
  • Premature menopause (permanent)
    
  • Infertility (permanent)
    

If you found this information helpful, please consider making a donation to the Rhode Island Cancer Council so we may continue adding content to our website and providing valuable services to Rhode Island residents. Please click the Donate icon to the left to make a donation via credit card or your PayPal account.

See also: