Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for people who have bladder cancer depend on the stage and grade of cancer. When deciding about your treatment, your doctor also considers your age, overall health, and quality of life.

Bladder cancer has a better chance of being treated successfully if it is found early.

Treatment choices for bladder cancer may include:

• Surgery to remove the cancer. Surgery, either alone or along with other treatments, is used in more than 9 out of 10 cases.¹ For more information, see Surgery.
• Chemotherapy to destroy cancer cells using medicines. Chemotherapy may be given before or after surgery. For more information, see Medications.
• 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. For more information, see Other Treatment.
• Immunotherapy. This treatment causes your body's natural defenses, known as your immune system, to attack bladder cancer cells. For more information, see Medications.

When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.

If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.

For more information about specific bladder cancer treatments, see the topics:

• Bladder Cancer–Health Professional Information [NCI PDQ]
• Bladder Cancer–Patient Information [NCI PDQ]

Side effects of treatment

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.

• 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. Mitomycin may cause skin peeling or a rash.
• 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). If you choose a surgeon who does many of these procedures, you will have fewer side effects and you will recover faster.
• Side effects of radiation may include nausea, vomiting, diarrhea, pain or discomfort when urinating, and bladder inflammation and scarring (radiation cystitis). You may also have an increased risk of infection.
• Side effects of immunotherapy vary depending on the medicine. Bacillus Calmette-Guerin (BCG) is a tuberculosis vaccine used in countries outside the United States. With BCG, the side effects may include fever, joint pain, inflammation of the prostate, or disseminated tuberculosis.

Home treatment measures may help you manage the side effects. For more information, see Home Treatment.

Body image and sexual 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 the bladder removed (radical cystectomy) will also have the 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.

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 doctor. Your doctor may also be able to refer you to groups that can offer support and information.

Bladder cancer that comes back

After initial treatment for bladder cancer, it is important to receive follow-up care, because bladder cancer often comes back (recurs). Your doctor will set up a regular schedule of checkups and tests.

Bladder cancer may recur in the bladder, or it may 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.

Palliative care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.

For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:

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