What is Bladder Cancer?

Female Urinary Tract
Female urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses called tumors. In bladder cancer, these tumors form in the bladder. The bladder is where urine (liquid waste made by the kidneys) is stored in the body.

In 2017, more than 79,000 Americans will be diagnosed with bladder cancer. Men are almost 4 times more likely than women to be diagnosed. About 16,000 Americans will die of bladder cancer this year. Over time, doctors have made progress with better treatments, and more people survive.

To understand bladder cancer, it helps to know how the bladder normally works.

The Bladder

Male Urinary Tract
Male urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

The bladder is a hollow, balloon-shaped organ, made mostly of muscle. It stores urine until you are ready to go to the bathroom to release it.

Urine is produced in the kidneys. It flows through tubes called ureters into the bladder. Urine leaves the body through the urethra. The bladder muscle helps you urinate by squeezing to force the urine out.

A thin surface layer called the urothelium lines the inside of the bladder. Next is a layer of loose connective tissue called the lamina propria. Covering that tissue is the bladder muscle. Outside the muscle is a layer of fat.

Layers of the Bladder
Layers of the bladder
Image © 2003 Fairman Studios, LLC.



What are the Symptoms of Bladder Cancer?

Hematuria (blood in the urine)

Blood in the urine is the most common symptom of bladder cancer. It is generally painless. Although blood may be visible, in most cases it is invisible except under a microscope. In these cases, blood is found when your urine is tested by your health care provider.

Blood alone does not mean that you have bladder cancer. There could be many reasons for blood in the urine, such as a urinary tract infection or kidney stones. Microscopic amounts of blood might even be normal in some people.

Frequent Urination and Pain on Urination (dysuria)

Frequent or painful urination is less common. If you have these symptoms, and do not have a urinary tract infection, you should talk to your health care provider to find out if bladder cancer is the cause.



What Causes Bladder Cancer?

We don't know all of the causes of bladder cancer, but there are certain things (known as risk factors) that can increase the chance of cancer developing.

Smoking

Cigarette, cigar, and pipe smoking increases your risk of bladder cancer. In fact, half of all bladder cancer cases in the United States are caused by cigarette smoke. Bladder cancer develops in smokers 2 to 3 times more than in nonsmokers.

When you smoke, you inhale chemicals from the tobacco. The chemicals move from your lungs into your blood. Your kidneys filter the chemicals out of your blood and send them to your bladder. Over time, these chemicals can damage the cells that line the inside of your bladder. This damage increases the chance of cancer developing.

Chemicals in the Workplace

Long-term exposure to chemicals used to make plastics, paints, textiles, leather and rubber may also cause bladder cancer. Hairdressers, machinists, printers, painters and truck drivers may be at risk for bladder cancer. Chemicals may cause about 23 out of every 100 bladder cancer cases. Like the chemicals in cigarette smoke, these chemicals (carcinogens) can remain in the bladder for a few hours before you urinate. In that way, the bladder becomes a place where cancer can develop.

Other Risk Factors

  • Frequent or long lasting bladder infections
  • Certain drugs for other cancers, such as cyclophosphamide (Cytoxan®)
  • Radiation therapy in the pelvic area, such as for cervical cancer or prostate cancer
  • High levels of arsenic in drinking water

More than 90% of all bladder cancers begin in the inner lining of the bladder (urothelium). Most tumors in the bladder stay in this area or in the next layer (the lamina propria) and don't move into the bladder muscle.



How is Bladder Cancer Diagnosed?

If you and your health care provider believe that you have a problem, you may be referred to a urologist. A urologist is a doctor who specializes in problems of the urinary system and male reproductive system.

There is no single test to check for bladder cancer. If you have symptoms of bladder cancer, your doctor may perform 1 or more of the following tests.

Medical History and Physical Exam

Your doctor will ask about your contact with things known to cause bladder cancer such as tobacco smoke (from your own use or secondhand smoke) or chemicals. You will also be asked if there is a family history of bladder cancer. Your doctor will check you for signs of disease.

Urinalysis

For this test you will provide a urine sample. Specialists will check the color of the urine and its contents. They may also perform urine cytology. For this, your urine is viewed under a microscope to look for cancer cells test . Urine can also be tested for other things linked with cancer cells (tumor markers).

Imaging Tests

Your doctor may request a computerized tomography (CT) scan. These scans are like X-rays, but they take more detailed pictures of your organs. Your doctor may order images of the kidneys, ureters and bladder to check for problems. If there is blood in the urine, it could have come from anywhere in the urinary tract. The scans will help the doctor see the problem. This is most often done with a CT urogram (CT scan focused on the urinary tract).

Cystoscopy

Cystoscopy
Cystoscopy
© 2010 Terese Winslow, U.S. Govt. has certain rights

Cystoscopy allows your doctor to see directly inside the bladder and inspect the inner surfaces for signs of cancer. It is most often done in the doctor's office. To make the test more comfortable, you will have local anesthesia (medicine to block pain in the area) or light sedation (to help you relax and to block pain). In some cases you may receive general anesthesia (to put you to sleep).

The urologist uses a cystoscope, which is a soft, thin tube with a light and a lens or a small video camera on the end. The cystoscope is moved through the opening of the urethra (where urine leaves your body) and into the bladder. The scope inserts sterile salt water to expand the bladder. This allows the doctor to get a better look at the bladder lining.

If tumors are present, the doctor notes their appearance, number, location and size.

Because removal (resection) of the tumors often cannot be done with local anesthesia alone, you may be scheduled to return for surgery to remove the tumor under general or spinal anesthesia. This surgery is called transurethral resection of bladder tumor (TURBT). (See Treatment section for more information on TURBT.)

Biopsy

If you are put to sleep for cystoscopy , your doctor can also do a biopsy. A biopsy is when samples of tissue are removed to see if cancer is present. A pathologist (a specialist who identifies changes in body tissue) examines the tissue under a microscope to check for cancer cells.

To remove tissue, the doctor inserts a resectoscope through the urethra into the bladder. This is a viewing instrument similar to the cystoscope, but it contains a wire loop at the end to remove the tissue.



What are the Grades and Stages of Bladder Cancer?

If cancer cells are found, your doctor will need to know the tumor stage and grade. Then the health care team can develop a treatment plan.

Grading

The grade tells how fast the tumor can grow and spread. The most common grading systems use 2 main grades:

  • Low-grade tumors grow more slowly. Though they may come back (recur) after treatment, they rarely spread to the muscle of the bladder. They also don't often spread to other parts of the body. The cells of low-grade tumors have only minor differences from normal cells.
  • High-grade tumors grow more quickly. They often recur after treatment and are more likely to spread to other parts of the body. The cells are disorganized and look abnormal.

Staging

Your doctor must learn if cancer cells have spread. This is called staging. Your doctor wants to find out:

  • if the tumor entered the muscle of the bladder (stage T2 and higher)
  • if the tumor has entered nearby tissues (stage T3 and higher)
  • if the cancer has spread to other parts of the body (stage T4)

In general, a higher stage cancer (4 is the highest) is more serious. The table lists the stages using the TNM (Tumor, Node, Metastasis) system .


Staging of primary bladder cancer tumors (T)

Stages of Bladder Cancer
Stages of bladder cancer
Image © 2003 Fairman Studios, LLC.

Ta: Tumor on the bladder lining. Most are low grade and do not enter the bladder muscle. May recur, but often at the same stage and grade.


Tis: Also called carcinoma in situ (CIS) a high-grade cancer that appears as a flat, reddish, velvety patch on the bladder lining. Tis can progress to enter the muscle layer.


T1: The tumor goes into the bladder lining but often does not reach the muscle layer of the bladder. May recur at a higher grade and stage.


T2a and T2b: The tumor goes into the muscle layer of the bladder.


T3a and T3b: The tumor passed through the muscle layer and into the tissues surrounding the bladder. It may have reached the prostate, uterus, or vagina.


T4a and T4b: The tumor has spread to nearby lymph nodes or to other parts of the body away from the bladder (metastatic cancer).



How is Bladder Cancer Treated?

A diagnosis of cancer is scary. The best treatment for you will depend on the type, grade, and stage of your bladder cancer. It also depends on your general health and age. You will want to work closely with your doctor to decide on a good treatment plan for you.

Treatment options for bladder cancer that has not entered the muscle (stages Ta, T1 and Tis) include:

Treatment options for bladder cancer that has entered the bladder muscle (stages T2, T3 and T4) include:



Surgery to Remove the Tumor

TURBT (Transurethral resection of a bladder tumor)
TURBT (Transurethral resection of a bladder tumor)
Image: Blamb/Shutterstock.com

This surgery, called TURBT (transurethral resection of bladder tumor), is the usual treatment for people who have tumors on the bladder lining (stage Ta and T1). The surgery is done during cystoscopy, so there is no cutting into the abdomen. You will be given general or spinal anesthesia.

If a tumor is clearly seen, the doctor can remove the entire tumor. A resectoscope is used to locate and remove tumor tissue. The doctor may also remove very small samples of other areas of the bladder that may be a concern. These samples will also be checked for grade and stage.

The doctor could use laser therapy, in which narrow beams of light cut and destroy the tumor. The results of laser therapy are like those of TURBT. However, an advantage of TURBT is that when the tissue is removed, it can be tested. With laser therapy the tumor tissue is damaged, so samples must be taken before the laser is used.

Once the tumor(s) is removed, your doctor may suggest intravesical therapy to prevent another tumor from growing.



Intravesical Therapy

With intravesical (meaning "within the bladder") therapy, the drug is put directly into your bladder through a catheter (a thin tube that is placed through the urethra). The catheter only stays in for a few minutes. You hold the drug in your bladder for 1 to 2 hours and then urinate it out. In general, you receive 6 weekly treatments.

Catheters used in intravesical therapy
Catheters used in intravesical therapy
Image: Blamb/Shutterstock.com

Intravesical therapy after TURBT is better than the surgery alone to prevent tumors from coming back. Your doctor may start intravesical chemotherapy right after surgery (in the recovery room). But immunotherapy is not used until after healing from surgery is complete.

Intravesical Immunotherapy

Immunotherapy is a treatment that boosts the ability of your immune system to fight the cancer. Bacillus Calmette-Guerin (BCG) is the immunotherapy drug used for bladder cancer. BCG has also been used as a tuberculosis vaccine. Generally, BCG is chosen for patients with stage T1 cancer or carcinoma in situ (CIS). These patients have a higher risk of cancer returning and spreading than those with stage Ta cancer. BCG is inserted into the bladder through a catheter. The therapy triggers the immune system to attack bladder cancer cells. It is one of the most effective treatments for bladder cancer, especially CIS. It is not recommended if you have a weak immune system or certain symptoms. Four out of 100 people given BCG end up with the bacteria infecting their whole body. More common side effects can include:

  • needing to urinate often
  • painful urination
  • flu-like symptoms
  • fever or chills
  • joint pain

Intravesical Chemotherapy

Chemotherapy drugs kill cancer cells. With intravesical chemotherapy, these drugs are placed directly into the bladder, rather than in the bloodstream. As a result, many common side effects - like hair loss - can be avoided. Because the drugs only reach the bladder lining, this type of treatment is only recommended for noninvasive bladder cancers.

Mitomycin C is the most common chemotherapy drug used for intravesical therapy of bladder cancer. Common side effects include:

  • needing to urinate often
  • painful urination
  • flu-like symptoms
  • skin rash

Repeat Intravesical Therapy

Some patients may respond to repeat therapy if the cancer returns. However, if you have high-grade Ta or T1 cancer or CIS, or you tried BCG and it did not work, you may need something else to control the cancer. In this case, you should talk to your doctor about surgery to remove the bladder.

Maintenance Therapy

After the bladder is free of disease, your doctor may suggest more treatment with the same drugs to keep the tumor from coming back. This may happen at the first 3-month appointment after treatment. Maintenance therapy seems to be more helpful for people who have had BCG than for those who have had chemotherapy drugs.



Surgery to Remove the Bladder

Surgery called cystectomy may be needed if you have cancer that could or has entered the bladder muscle. In this case, all or part of the bladder may be removed. If you have CIS, or high grade Ta or T1 cancer that has not improved or has returned after treatment, your doctor may recommend this surgery. If your cancer has a high risk of spreading into the muscle, you may want to consider cystectomy as a first choice.

Male and Female Bladder and Urethra
Male and Female Bladder and Urethra
Image © 2003 Fairman Studios, LLC.

Partial Cystectomy (removal of part of the bladder)

For some people with a single, small tumor in the bladder, the surgeon does not remove the entire bladder. The surgeon removes the tumor, the part of the bladder containing the tumor, and nearby lymph nodes. After part of the bladder is removed, you may not be able to hold as much urine in your bladder as before surgery. You may need to empty your bladder more often. This problem usually gets better with time. 1

Radical Cystectomy (removal of the whole bladder)

For bladder cancer that has invaded the muscle layer (Stage 2 or some Stage 3), the most common type of surgery is radical cystectomy. The surgeon removes the entire bladder, nearby lymph nodes, and part of the urethra. In addition, the surgeon usually removes the prostate from a man and may remove the uterus from a woman. Other nearby tissues may also be removed. 2

When the entire bladder is removed, the surgeon makes another way for urine to be collected from the kidneys and stored. You may wear a flat bag outside the body under your clothes, or the surgeon may use part of your intestine to create a pouch inside the body. 3

Ask your doctor about the risks of cystectomy and the methods of urinary reconstruction. Also called urinary diversion, this surgery creates a new way to store and remove urine after your bladder is removed.

When the prostate or uterus is removed, a man can no longer father a child and a woman can no longer get pregnant. Also, a man may be unable to have sex after surgery. If the surgeon removes part of a woman's vagina, sex may be difficult. 4

Because bladder cancer surgery may affect your sex life, it may help you and your partner to talk about your feelings and help one another find ways to share intimacy during and after treatment. 5

If you have a partner, you may be worried about maintaining sexual intimacy and your relationship. If you do not have a partner, you may want help talking through how to manage your dating life after bladder cancer surgery. Either way, you (and your partner) may benefit from the advice of a counselor who specializes in discussing sexual issues. Your urologist may be able to refer you to medical professionals and counselors who specialize in sexual issues after cancer treatment. You can also find a certified sex therapist near you  on the website of the  American Association of Sexuality Educators, Counselors and Therapists.

It takes time to heal after surgery, and the time needed to recover is different for each person. It's common to feel weak or tired for a while. 6

Also, you may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control. 7



Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used to treat bladder cancer before or after surgery.

You may receive chemotherapy in different ways:

  • By mouth: Some drugs are pills that you can swallow. They may be given before or after surgery.
  • Into a vein: For cancer that has invaded the muscle of the bladder or spread to other tissues, drugs are usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body. Intravenous chemotherapy may also be given before or after surgery.

You may have your treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, you may need to stay in the hospital.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.

If the drugs are given by vein or taken by mouth, the side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive system: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

Some drugs used for bladder cancer may also cause tingling or numbness in your hands and feet. Your health care team can suggest ways to control many of these side effects.



Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be given after surgery. Usually it's given along with chemotherapy for cancer that has invaded the muscle layer of the bladder. However, it is sometimes given instead of surgery or chemotherapy.

The radiation comes from a large machine. The machine aims beams of radiation at the bladder area in the abdomen.

You'll go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each treatment session takes about 30 minutes.

Although radiation therapy is painless, it may cause other side effects. The side effects include nausea, vomiting, or diarrhea. Also, you may feel very tired during radiation therapy. Your health care team can suggest ways to treat or control these side effects.



Surgery to Remove the Tumor

TURBT (Transurethral resection of a bladder tumor)
TURBT (Transurethral resection of a bladder tumor)
Image: Blamb/Shutterstock.com

This surgery, called TURBT (transurethral resection of bladder tumor), is the usual treatment for people who have tumors on the bladder lining (stage Ta and T1). The surgery is done during cystoscopy, so there is no cutting into the abdomen. You will be given general or spinal anesthesia.

If a tumor is clearly seen, the doctor can remove the entire tumor. A resectoscope is used to locate and remove tumor tissue. The doctor may also remove very small samples of other areas of the bladder that may be a concern. These samples will also be checked for grade and stage.

The doctor could use laser therapy, in which narrow beams of light cut and destroy the tumor. The results of laser therapy are like those of TURBT. However, an advantage of TURBT is that when the tissue is removed, it can be tested. With laser therapy the tumor tissue is damaged, so samples must be taken before the laser is used.

Once the tumor(s) is removed, your doctor may suggest intravesical therapy to prevent another tumor from growing.



Intravesical Therapy

With intravesical (meaning "within the bladder") therapy, the drug is put directly into your bladder through a catheter (a thin tube that is placed through the urethra). The catheter only stays in for a few minutes. You hold the drug in your bladder for 1 to 2 hours and then urinate it out. In general, you receive 6 weekly treatments.

Catheters used in intravesical therapy
Catheters used in intravesical therapy
Image: Blamb/Shutterstock.com

Intravesical therapy after TURBT is better than the surgery alone to prevent tumors from coming back. Your doctor may start intravesical chemotherapy right after surgery (in the recovery room). But immunotherapy is not used until after healing from surgery is complete.

Intravesical Immunotherapy

Immunotherapy is a treatment that boosts the ability of your immune system to fight the cancer. Bacillus Calmette-Guerin (BCG) is the immunotherapy drug used for bladder cancer. BCG has also been used as a tuberculosis vaccine. Generally, BCG is chosen for patients with stage T1 cancer or carcinoma in situ (CIS). These patients have a higher risk of cancer returning and spreading than those with stage Ta cancer. BCG is inserted into the bladder through a catheter. The therapy triggers the immune system to attack bladder cancer cells. It is one of the most effective treatments for bladder cancer, especially CIS. It is not recommended if you have a weak immune system or certain symptoms. Four out of 100 people given BCG end up with the bacteria infecting their whole body. More common side effects can include:

  • needing to urinate often
  • painful urination
  • flu-like symptoms
  • fever or chills
  • joint pain

Intravesical Chemotherapy

Chemotherapy drugs kill cancer cells. With intravesical chemotherapy, these drugs are placed directly into the bladder, rather than in the bloodstream. As a result, many common side effects - like hair loss - can be avoided. Because the drugs only reach the bladder lining, this type of treatment is only recommended for noninvasive bladder cancers.

Mitomycin C is the most common chemotherapy drug used for intravesical therapy of bladder cancer. Common side effects include:

  • needing to urinate often
  • painful urination
  • flu-like symptoms
  • skin rash

Repeat Intravesical Therapy

Some patients may respond to repeat therapy if the cancer returns. However, if you have high-grade Ta or T1 cancer or CIS, or you tried BCG and it did not work, you may need something else to control the cancer. In this case, you should talk to your doctor about surgery to remove the bladder.

Maintenance Therapy

After the bladder is free of disease, your doctor may suggest more treatment with the same drugs to keep the tumor from coming back. This may happen at the first 3-month appointment after treatment. Maintenance therapy seems to be more helpful for people who have had BCG than for those who have had chemotherapy drugs.



Surgery to Remove the Bladder

Surgery called cystectomy may be needed if you have cancer that could or has entered the bladder muscle. In this case, all or part of the bladder may be removed. If you have CIS, or high grade Ta or T1 cancer that has not improved or has returned after treatment, your doctor may recommend this surgery. If your cancer has a high risk of spreading into the muscle, you may want to consider cystectomy as a first choice.

Male and Female Bladder and Urethra
Male and Female Bladder and Urethra
Image © 2003 Fairman Studios, LLC.

Partial Cystectomy (removal of part of the bladder)

For some people with a single, small tumor in the bladder, the surgeon does not remove the entire bladder. The surgeon removes the tumor, the part of the bladder containing the tumor, and nearby lymph nodes. After part of the bladder is removed, you may not be able to hold as much urine in your bladder as before surgery. You may need to empty your bladder more often. This problem usually gets better with time. 1

Radical Cystectomy (removal of the whole bladder)

For bladder cancer that has invaded the muscle layer (Stage 2 or some Stage 3), the most common type of surgery is radical cystectomy. The surgeon removes the entire bladder, nearby lymph nodes, and part of the urethra. In addition, the surgeon usually removes the prostate from a man and may remove the uterus from a woman. Other nearby tissues may also be removed. 2

When the entire bladder is removed, the surgeon makes another way for urine to be collected from the kidneys and stored. You may wear a flat bag outside the body under your clothes, or the surgeon may use part of your intestine to create a pouch inside the body. 3

Ask your doctor about the risks of cystectomy and the methods of urinary reconstruction. Also called urinary diversion, this surgery creates a new way to store and remove urine after your bladder is removed.

When the prostate or uterus is removed, a man can no longer father a child and a woman can no longer get pregnant. Also, a man may be unable to have sex after surgery. If the surgeon removes part of a woman's vagina, sex may be difficult. 4

Because bladder cancer surgery may affect your sex life, it may help you and your partner to talk about your feelings and help one another find ways to share intimacy during and after treatment. 5

If you have a partner, you may be worried about maintaining sexual intimacy and your relationship. If you do not have a partner, you may want help talking through how to manage your dating life after bladder cancer surgery. Either way, you (and your partner) may benefit from the advice of a counselor who specializes in discussing sexual issues. Your urologist may be able to refer you to medical professionals and counselors who specialize in sexual issues after cancer treatment. You can also find a certified sex therapist near you  on the website of the  American Association of Sexuality Educators, Counselors and Therapists.

It takes time to heal after surgery, and the time needed to recover is different for each person. It's common to feel weak or tired for a while. 6

Also, you may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control. 7



Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used to treat bladder cancer before or after surgery.

You may receive chemotherapy in different ways:

  • By mouth: Some drugs are pills that you can swallow. They may be given before or after surgery.
  • Into a vein: For cancer that has invaded the muscle of the bladder or spread to other tissues, drugs are usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body. Intravenous chemotherapy may also be given before or after surgery.

You may have your treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, you may need to stay in the hospital.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.

If the drugs are given by vein or taken by mouth, the side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive system: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

Some drugs used for bladder cancer may also cause tingling or numbness in your hands and feet. Your health care team can suggest ways to control many of these side effects.



Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be given after surgery. Usually it's given along with chemotherapy for cancer that has invaded the muscle layer of the bladder. However, it is sometimes given instead of surgery or chemotherapy.

The radiation comes from a large machine. The machine aims beams of radiation at the bladder area in the abdomen.

You'll go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each treatment session takes about 30 minutes.

Although radiation therapy is painless, it may cause other side effects. The side effects include nausea, vomiting, or diarrhea. Also, you may feel very tired during radiation therapy. Your health care team can suggest ways to treat or control these side effects.



What about Clinical Trials?

Are you interested in participating in a clinical trial for bladder cancer? Clinical trials are research studies to test if a new treatment or procedure is safe and effective. The goal is also to learn which treatments work best for certain illnesses or groups of people.

Clinical trials follow strict scientific standards. These standards protect patients and help produce reliable study results.

Ask your doctor if you qualify for a clinical trial. Learn as much as you can about the benefits and risks of the study. To search for information on current clinical trials for the treatment of bladder cancer, visit the UrologyHealth.org Clinical Trials Resource Center.



What Can I Expect After Treatment?

Follow-up

Once treatment is completed, your doctor will want to continue to watch you closely. With bladder cancer, it can be common for tumors to come back (recur). You may be asked to visit your doctor 3 to 4 times per year to check your health. These visits may include cystoscopy. If things look good, check-ups may drop to once or twice per year over time.

Lifestyle

If you have bladder cancer, taking good care of your health is important.

• Follow a healthy eating plan.
• Exercise regularly if you can.



More Information

Questions to Ask Your Health Care Provider

  • What type of bladder cancer do I have?
  • Has it spread beyond my bladder?
  • What is the stage and grade of my cancer, and what does that mean?
  • Do I need other tests before we can decide on treatment?
  • Will I need to see other doctors?
  • What are my treatment options and which do you recommend? Why?
  • What are the chances my cancer can be cured?
  • What are the chances that my cancer will return after treatment?
  • What risks or side effects should I expect? How long are they likely to last?
  • What should I do to prepare for treatment? What will it be like?
  • How much time will I need to recover from treatment?
  • If I have surgery, how long will I have a catheter?
  • How long will I need to take off from work or other activities?
  • Will the surgery affect my sex life? My social life?
  • What will we do if the treatment doesn't work or if the cancer comes back?
  • Is there anything I can do to prevent the cancer from returning after treatment?
  • How often will I need to have check-ups after treatment?

Other Information

Bladder Cancer Advocacy Network

Website

National Cancer Institute at the National Institutes of Health
Website

National Library of Medicine
Website
Spanish Version

American Association of Sexuality Educators, Counselors, and Therapists
Find a certified sex therapist/counselor near you
Website

Frank Talk
Peer support to help men deal with Erectile Dysfunction
Website