Treatment and Prevention
Like most cancers, bladder cancer can be treated by surgery, radiotherapy,
chemotherapy, or a combination of therapies. The choice of treatment depends
on the location and the staging of the cancer.
Surgery
When bladder cancer is caught early, a transurethral resection (TUR)
can be done. Using a cystoscope, the doctor uses a special tool to burn away
the cancerous cells inside the bladder. The advantage of this treatment is that
the bladder stays intact and people can still urinate normally after the procedure.
Surgery to remove the bladder is called a cystectomy. If the cancer
has invaded through the bladder wall, or if it covers a large portion of the
bladder, surgeons generally choose this surgery over TUR.
In women, removing the bladder usually involves also removing the uterus (hysterectomy),
fallopian tubes, ovaries, and part of the vagina. If the woman is young, the
ovaries might be left intact so that she won't have early menopause. For men,
the prostate and the seminal vesicles (the glands that produce semen)
must usually be removed along with the bladder.
Occasionally, an operation called a segmental cystectomy may be performed
if the cancer is limited to a small part of the bladder wall. This surgery
doesn't remove the entire bladder, so people can still urinate normally afterward.
Radiotherapy
There are two types of radiotherapy used to treat bladder cancer, internal
and external.
External radiotherapy aims radiation directly at the cancer cells in
the bladder. It may be done prior to surgery to shrink the size of the tumor,
or after the surgery along with chemotherapy.
Internal radiotherapy is done by inserting radiation implants directly
into the bladder. This treatment requires a hospital stay. Visitors might not
be allowed; this is to avoid exposing them to the radiation coming from the
person being treated. Once the implants are removed, no more radiation is released
and the person can return home from the hospital.
Some people receive both internal and external radiation.
Side effects of radiotherapy include:
- fatigue
- red, dry skin at the radiation site
- nausea
- decreased appetite
- diarrhea
The side effects of radiotherapy are usually temporary.
Chemotherapy
Chemotherapy can be used alone or in combination with surgery and/or radiotherapy.
It's available as a general treatment (usually given intravenously) or
a local one.
Local chemotherapy, or intravesical therapy, involves putting
chemotherapy drugs directly into the bladder for several hours at a time. The
greatest advantage to intravesical treatment is that there are fewer side effects
since the drugs are not given systemically (throughout the body). This approach is usually reserved for superficial tumors removed during a cystoscopy, both to treat tiny amounts of tumor left behind, or to prevent recurrence after successful removal.
General, or systemic, chemotherapy circulates throughout the
body, so more of the body systems are affected by the treatment. This approach
is used if the cancer has spread and can't be reached by the local (intravesical)
approach.
Side effects from chemotherapy include:
- nausea and vomiting
- hair loss
- fatigue
- diarrhea
- chills
- shortness of breath
- coughing
- mouth sores
The prognosis (or outlook) for bladder cancer is good. The sooner
the cancer is discovered, the better the chances of survival. The five-year
survival rate can be as high as 94% if the cancer is detected early. However,
this drops dramatically once the cancer has spread to other areas of the body.
If bladder cancer does return, it most often happens within the first year
or two after treatment, so good follow-up is essential. This involves cystoscopies
and urine tests at least every three months for a couple of years.
While some of the risk factors for bladder cancer can't be avoided (age
and gender, for example), there are some precautions that can be taken to help
avoid developing it. For those who work with high-risk chemicals, it's important
to have urine tests as part of general annual physical examinations. Any unusual
bladder symptoms should be checked by a doctor immediately.
Since smoking is a known risk factor for getting bladder cancer, smokers should
try to quit or ask their doctor about ways to quit.
*All medications have both common (generic) and brand names. The brand name
is what a specific manufacturer calls the product (e.g., Tylenol®).
The common name is the medical name for the medication (e.g., acetaminophen).
A medication may have many brand names, but only one common name. This article
lists medications by their common names. For more information on brand names,
speak with your doctor or pharmacist.