Many people with bladder cancer want to take an active part in decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people often feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.
The doctor may refer patients to doctors who specialize in treating cancer, or patients may ask for a referral. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about bladder cancer.
People with bladder cancer have many treatment options. They may have surgery, radiation therapy, chemotherapy, or biological therapy. Some patients get a combination of therapies.
The doctor is the best person to describe treatment choices and discuss the expected results of treatment.
Surgery
Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. The doctor can explain each type of surgery and discuss which is most suitable for the patient.
Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, the surgeon removes the bladder but does not try to get rid of all the cancer. Or, the surgeon does not remove the bladder but makes another way for urine to leave the body. The goal of the surgery may be to relieve urinary blockage or other symptoms caused by the cancer.
When the entire bladder is removed, the surgeon makes another way to collect urine. The patient may wear a bag outside the body, or the surgeon may create a pouch inside the body with part of the intestine.
Radiation therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.
A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.
Doctors use two types of radiation therapy to treat bladder cancer:
Some patients with bladder cancer receive both kinds of radiation therapy.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. The doctor may use one drug or a combination of drugs.
For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.
If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.
The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay.
Biological therapy (also called immunotherapy) uses the body's natural ability (immune system) to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. This helps prevent the cancer from coming back.
The doctor may use intravesical biological therapy with BCG solution. BCG solution contains live, weakened bacteria. The bacteria stimulate the immune system to kill cancer cells in the bladder. The doctor uses a catheter to put the solution in the bladder. The patient must hold the solution in the bladder for about 2 hours. BCG treatment is usually done once a week for 6 weeks.
