Health Library Bladder CancerFrom Healthwise

What is bladder cancer?

Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, called tumors. In bladder cancer, these growths happen in the bladder.

The bladder is the part of your urinary tract that stores your urine until you are ready to let it out. See a picture of the female urinary system or male urinary system.

Bladder cancer can usually be cured if it is found and treated early. And most bladder cancer is found early.

What causes bladder cancer?

We don't know what causes bladder cancer. But we do know that smokers are much more likely to get it than nonsmokers. In fact, experts believe that smoking causes about half of bladder cancer in men and more than one-fourth of bladder cancer in women.

What are the symptoms?

Blood in the urine is the main symptom. Other symptoms may include having to urinate often or feeling pain when you urinate.

These symptoms can be caused by other problems, including a urinary tract infection. Always call your doctor if you see blood in your urine.

How is bladder cancer diagnosed?

To diagnose bladder cancer, your doctor will:

• Ask about your medical history and do a physical exam, including a vaginal or rectal exam.
• Test your urine to look for blood or abnormal cells.
• Do a cystoscopy, a test that lets your doctor look into your bladder with a thin, lighted viewing tool. Small tissue samples ( biopsies) are taken and looked at under a microscope to find out if there are cancer cells.

How is it treated?

Treatment choices for bladder cancer include surgery to remove the cancer, anti-cancer drugs (chemotherapy), medicines that help your immune system ( biological therapy), and radiation.

The treatment depends a lot on how much the cancer has grown. Most bladder cancers are treated without having to remove the bladder.

Sometimes doctors do have to remove the bladder. For some people, this means having urine flow into a bag outside of the body. But in many cases, doctors can make a new bladder—using other body tissue—that works very much like the old one.

Bladder cancer often comes back. The new tumors can often be treated easily if they are caught early. So it’s very important to have regular checkups after your treatment is done.

It’s common to feel scared, sad, or angry after finding out that you have bladder cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

What increases your chances of getting bladder cancer?

Anything that increases your chances of getting a disease is called a risk factor. The main risk factor for bladder cancer is smoking. Cigarette smokers are much more likely than other people to get bladder cancer.

Other risk factors include:

• Being older than 40.
• Being male. Men are 4 times more likely than women to get bladder cancer.
• Being exposed to cancer-causing chemicals, such as those used in the wood, rubber, and textile industries.

Frequently Asked Questions

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The cause of bladder cancer is not known. Changes in the genetic material ( DNA) of bladder cells may play a role.

Bladder cancer is twice as likely to develop in smokers than in nonsmokers. Experts believe that smoking causes about half of bladder cancer in men and more than one-fourth of bladder cancer in women.¹

Exposure to chemicals and other substances at work—including dyes, paints, leather dust, and others—may also cause bladder cancer.^{1, 2}

The 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.²
• 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.

Bladder cancer is the rapid, uncontrolled growth of abnormal cells in the bladder. Cancer usually begins in the lining of the bladder (superficial bladder cancer). The cancerous cells may grow through the lining into the muscular wall of the bladder. Invasive bladder cancer may spread to lymph nodes, other organs in the pelvis (causing problems with kidney and bowel function), or other organs in the body, such as the liver and lungs.

Bladder cancer is classified by stage and grade. The stage is determined by the cancer growth in the bladder wall and how far it has spread to nearby tissues and other organs, such as the lungs, the liver, or the bones. The grade of bladder cancer is determined by how the cancer cells look in comparison with normal bladder cells.

Your health professional determines the stage and grade of your bladder cancer by gathering information from a variety of tests, including blood tests, urine tests, biopsies, bone scans, X-rays, and CT scans. The stage and grade of your cancer are important factors in selecting the treatment option that is right for you.

Bladder cancer is usually curable if it is diagnosed while the cancer is still contained in the bladder, and up to 80% of bladder cancers are diagnosed at this early stage.³Survival rates decrease as the stage of cancer becomes more advanced, as the cancer cells become more abnormal (grade), and when the cancer involves lymph nodes or other body organs.¹

The major risk factors for bladder cancer include:

• Smoking.
  • Cigarette smokers are twice as likely to develop bladder cancer as nonsmokers.¹
  • Pipe and cigar smokers have a slightly increased risk compared to nonsmokers, but the risk is significantly less than it is for cigarette smokers.⁴
• Being older than 40. Your risk goes up as you get older, and most people who get bladder cancer are in their 60s.¹
• Being male. Men are 4 times more likely than women to develop bladder cancer.¹
• 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.⁵
• Exposure to cancer-causing materials (carcinogens) may cause up to 20% of bladder cancer cases in the United States. It may take years (as many as 30 to 50) for cancer to appear. This risk may also depend on how much of the material a person is repeatedly exposed to over time.⁶ Chemical exposure can be a risk for many types of workers from truck drivers to textile workers to hair-stylists. It has been linked to chemicals called aromatic amines that are found in many products, including dyes, paints, solvents, inks, and the dust from leather.⁷
• 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.

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

Call your health professional 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 health professional. 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.

Health professionals who can manage your cancer treatment include:

• Urologists.
• Medical oncologists.
• Radiation oncologists.

To prepare for your appointment, see the topic Making the Most of Your Appointment

To determine whether bladder cancer may be the cause of your urinary symptoms, your health professional will evaluate your:

• Physical symptoms. A physical exam may include a rectal exam, a prostate exam for men, or a pelvic exam for women.
• Medical history, including your smoking history and your possible exposure to cancer-causing chemicals.
• Family history of cancer.
• A urine test and urine culture, to determine the presence of blood, infection, and other abnormal cells.

Initial diagnostic tests will include a cystoscopy, a test that allows your doctor to look at your bladder with a thin lighted scope (cytoscope). Small tissue samples ( biopsies) of any abnormal areas are taken and looked at under a microscope to determine whether cancer cells are present and what the cells look like ( grade). Information from the biopsy, cytoscopy, and sometimes other tests is used to determine the size and extent of the cancer ( stage). Cancer stage and grade tell the size and shape of cancer cells and whether they have spread to other body areas. Knowing the stage and grade helps you and your doctor make treatment decisions.

Other diagnostic tests that may be done include:

• A complete blood count (CBC), to determine whether you have anemia.
• A chemistry screen, to evaluate kidney, liver, and bone functions.
• An intravenous pyelogram or computed tomography (CT urogram) to look for a mass near the kidneys, ureters, or bladder.
• A pelvic ultrasound, to determine whether a mass is present in or around the bladder and/or the kidneys.

If bladder cancer is diagnosed, more tests may be needed to determine whether the cancer has spread (metastasized).

• A CT scan or MRI may be done to determine whether the cancer has spread to lymph nodes, the lungs, the liver, or other abdominal organs.
• A chest X-ray may be done to determine whether the cancer has spread to the lungs.
• A barium enema or colonoscopy may be done to determine whether the cancer involves the intestines.
• A bone scan may be done to determine whether the cancer has spread to the bones.

Early detection of returning cancer

After you have been treated for bladder cancer, it is important to have regular examinations and cystoscopies to detect any recurrence early so that additional treatment can begin immediately. Researchers are studying ways to identify low-grade cancer cells without the need for a cystoscopy. Some tests for specific proteins in cancer cells (tumor markers), such as BTA and NMP22, have been approved by the U.S. Food and Drug Administration (FDA) to use to detect recurrent cancer.⁸ More research is being done on these screening methods because they are not as accurate as a cystoscopy at this time.⁹

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 health professional 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 up to 80% of bladder cancers are diagnosed at this early stage.³

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.¹
• Chemotherapy to destroy cancer cells using medications. 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.
• Biological therapy to boost your body's immune system to fight cancer cells. This therapy is commonly used to prevent the return (recurrence) of bladder cancer.

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 cytoscopy.
• Transurethral resection (TUR) is used to remove large superficial 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 medications to destroy cancer cells. For superficial bladder cancer, the medications 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 medications used and your age and overall health. Recent studies show that chemotherapy given before cystectomy ( neoadjuvant) may increase the effectiveness of treatment for many people.^{10, 11} More studies are being done.

Radiation therapy, which uses high-dose X-rays or other high-energy rays to destroy cancer cells, is one of the standard treatments for certain types of bladder cancer. 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.

Biological therapy uses medications to boost or restore your body's immune system. Biological therapy is most often used for superficial 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 experience 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 health professional. 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, about 94% of people live at least 5 years after they are diagnosed.¹ The long-term outcome (prognosis) for men older than 65, African Americans, and those who smoke is worse than for other people with bladder cancer.²

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:¹²

• 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 examinations 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.²

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 health professional. 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 health professional 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.
• 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).

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 than 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 cannot be prevented, but you may be able to reduce some of your risk factors for developing it.²

• Cigarette smokers are much more likely to develop bladder cancer than nonsmokers. However, after 1 to 4 years of not smoking, the risk of developing bladder cancer decreases by 40%. Do not smoke or use other tobacco products, and avoid exposure to cigarette smoke. For more information, see the topic Quitting Tobacco Use.
• 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 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.
  • Eat a low-fat, low-cholesterol diet that includes plenty of fruits and vegetables. For more information, see the topic Healthy Weight.
  • Avoid dehydration. Increase your fluid intake, particularly water. Water dilutes cancer-causing chemicals.
  • Vitamin A and vitamin C supplements may provide some protection against bladder cancer.

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 health professional has given you instructions or medications 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. For more information on how to deal with these side effects, see:

  Cancer: Controlling nausea and vomiting from chemotherapy.

• Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your health professional before using any nonprescription medications 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 consulting your health professional.

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 naps.
• 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. Sexual 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.
  • Women who have their bladder removed (radical cystectomy) will also have their ovaries and uterus removed. They cannot become pregnant and may experience menopause soon after having the cystectomy.
  • 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 undergo 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 health professional. Your health professional may also be able to refer you to organizations that can offer additional 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 health professional has given you instructions or medications 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 any home treatment you use for pain with your health professional.

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. For more information, see the topics:

• Hospice Care.
• Care at the End of Life.

Medications may be used to control the growth of bladder cancer cells and to relieve symptoms. Chemotherapy uses medications to destroy cancer cells. Biological therapy boosts or restores your body's immune response to destroy cancer cells.

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.

Medications 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 medications. 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 medication. Epirubicin and valrubicin are also anthracycline antibiotics that may be used.
• Paclitaxel or carboplatin are antitumor medications that slow or stop the growth of cancer cells in the body.

Medications 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 biological therapy.
• Mitomycin C 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

Medications, 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 health professional has given you instructions or medications 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 of other medications, such as interferon or chemotherapy before surgery ( neoadjuvant), are ongoing. Ask your doctor about participating in a clinical trial.

There are two main surgeries for bladder cancer.

• Transurethral resection (TUR) removes cancerous cells from the bladder.
• Cystectomy removes all or part of the bladder if cancer has spread into the bladder muscle.

Surgery Choices

Surgery to remove cancer

Transurethral resection (TUR) is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder.

Surgery to remove bladder

Cystectomy is the surgical removal of all (total or radical cystectomy) or part (partial cystectomy) of the bladder. It is used to treat bladder cancer that has spread into the bladder wall ( stages II and III) as either a first occurrence or as a cancer that returns (recurs) following initial treatment. A radical cystectomy removes the whole bladder as well as the surrounding pelvic organs.

Following surgery to remove the bladder, your surgeon will create a new channel for urine to pass from your body.¹³

• An ileal conduit (also called a noncontinent diversion) uses a segment of your intestine to create a channel that connects your ureters to a surgically created opening (stoma) on your abdomen. This procedure is called a urostomy. After a urostomy, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin. You will empty the bag 3 or 4 times a day, and a larger bag that allows for longer storage can be worn overnight. You will also learn how to care for your urostomy.
• A continent reservoir (continent diversion) uses a segment of your intestine to create a storage pouch that is attached inside your abdomen. There are two types of internal continent reservoirs.
  • Abdominal diversion reservoir. The pouch inside the abdomen connects to an opening (stoma) in the skin. This is another form of urostomy. The opening is smaller than the opening for an ileal conduit, and because there is a pouch inside the abdomen no bag needs to be worn outside your body. You will need to pass a catheter through the opening to release the urine several times a day and during the night.
  • Orthotopic diversion. The pouch in this procedure is sometimes called a bladder substitution reservoir. If your urethra was not removed as part of the cystectomy, you may be able to have this type of procedure. In an orthotopic diversion, the pouch is attached to your ureters at one end and your urethra at the other. This allows you to pass urine through the same opening as you did before surgery. Some people may need to use a catheter to release the urine.

Noncontinent diversions are simpler and may have fewer complications either right after surgery or in the coming months and years. Continent diversion reservoirs eliminate the need for a urine storage bag to be worn outside the body.

What To Think About

Side effects from your surgery can include problems with bowel functioning, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

Adhesions may develop after surgery, and a bowel obstruction may occur as a complication if surgery was extensive.

Radiation treatment for bladder cancer uses high-energy X-rays to kill cancer cells and shrink tumors. External beam radiation comes from a machine outside the body. The machine aims radiation at the area where the cancer cells are found.

Photodynamic therapy (PDT) is being studied as a treatment for bladder cancer. PDT uses laser light and a special light-activated substance (Photofrin) to kill cancer cells. Results of early studies with photosensitizers show that PDT may be effective in treating recurrent superficial bladder cancer.^{8, 14} Until all the drug is out of the body, the skin can get a sort of sunburn after even short exposures to light. This can last several weeks.¹⁵

Other Treatment Choices

Radiation treatment uses high-dose X-rays to kill cancer cells and shrink tumors. It may be used before or after surgery. Radiation therapy also may be used if a person with bladder cancer cannot have surgery. Radiation therapy also may be used as palliative care to shrink tumors or relieve pain.

What To Think About

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 the United States and in some other countries for people with all stages of bladder cancer.

The combination of conventional medical treatment and complementary medicine is an approach that is sometimes termed integrative medicine, in which conventional and complementary therapies work together for the best outcome.

Organizations

• Urinary Tract Infections in Teens and Adults

Citations

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2. Pashos CL, et al. (2002). Bladder cancer epidemiology, diagnosis, and management. Cancer Practice, 10(6): 311–322.

3. National Cancer Institute (2006). Bladder Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional.

4. Small EJ, Grossfeld GD (2003). Bladder. In M Dollinger et al., eds., Everyone's Guide to Cancer Therapy, 4th ed., pp. 401–411. Kansas City: Andrews McMeel.

5. Cancer of the urinary bladder (2005). In Cancer Stat Fact Sheets based on LAG Ries et al., eds., SEER Cancer Statistics Review, 1975–2003. National Cancer Institute: Bethesda, MD. Available online: http://seer.cancer.gov/statfacts/html/urinb.html.

6. Messing EM (2002). Urothelial tumors of the urinary tract. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 4, pp. 2732–2784. Philadelphia: W.B. Saunders.

7. Kim HL, Belldegrun A (2005). Bladder cancer section of Urology. In FC Brunicardi et al., eds., Schwartz's Principles of Surgery, 8th ed., pp. 1532–1535. New York: McGraw-Hill.

8. American Cancer Society (2006). American Cancer Society's Detailed Guide: Bladder Cancer. Available online: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=44.

9. Black PC, et al. (2006). Molecular markers of urothelial cancer and their use in the monitoring of superficial urothelial cancer. Journal of Clinical Oncology, 24(35): 5528–5535.

10. Winquist E, et al. (2004). Neoadjuvant chemotherapy for transitional cell carcinoma of the bladder: A systemic review and meta-analysis. Journal of Urology, 171 (2): 561–569.

11. Vale CL, et al. (2003). Neoadjuvant chemotherapy in invasive bladder cancer: A systemic review and meta-analysis. Lancet, 361 (9373): 1927–1934.

12. National Comprehensive Cancer Network (2007). Bladder cancer. Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf.

13. Shipley WU, et al. (2005). Cancer of the bladder, ureter, and renal pelvis. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1168–1185. Philadelphia: Lippincott Williams and Wilkins.

14. Jiminez VK, Marshall FF (2002). Surgery of bladder cancer. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 4, chap. 79, pp. 2819–2844. Philadelphia: W.B. Saunders.

15. American Cancer Society (2007). Making Treatment Decisions: Lasers in Cancer Treatment. Available online: http://www.cancer.org/docroot/ETO/content/ETO_1_2x_Lasers_In_Cancer_Treatment.asp.

Author:	Shannon Erstad, MBA/MPH	Last Updated: May 25, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Philip Belitsky, MD, FRCSC - Urology
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