Medical Treatment

Standard therapies for bladder cancer include surgery, radiation therapy, chemotherapy, and immunotherapy or biological therapy.

• Surgery and radiation therapy are local therapies. This means that they get rid of cancer cells only in the treated area.
  
  
• Chemotherapy is systemic therapy. This means that it can kill cancer cells almost anywhere in the body.
  
  
• For more information, see the Surgery section.

Radiation Therapy

Radiation is a high-energy ray that kills cancer cells and normal cells in its path. Radiation may be given for small muscle-invasive bladder cancers. It is commonly used as an alternative approach to surgery. Either of two types of radiation can be used. However, for greatest therapeutic efficacy, it should be given in conjunction with chemotherapy:

• External radiation is produced by a machine outside the body. The machine targets a concentrated beam of radiation directly at the tumor. This form of therapy is usually spread out in short treatments given five days a week for five to seven weeks. Spreading it out this way helps protect the surrounding healthy tissues by lowering the dose of each treatment. External radiation is given at the hospital or medical center. You come to the center each day as an outpatient to receive your radiation therapy.
  
  
• Internal radiation is given by placing a small pellet of radioactive material inside the bladder. The pellet can be inserted through the urethra or by making a tiny incision in the lower abdominal wall. You have to stay in the hospital during the entire treatment, which lasts several days. Visits by family and friends are restricted to protect them from the effects of radiation. When the treatment is done, the pellet is removed and you are allowed to go home. This form of radiation is rarely used for bladder cancer in the United States.

Unfortunately, radiation affects not only cancer cells but also any healthy tissues it touches. With external radiation, healthy tissue overlying or adjacent to the tumor can be damaged. The side effects of radiation depend on the dose and the area of the body where the radiation is targeted.

• The area of your skin where the radiation passes through may become reddened, sore, dry, or itchy. The effect is not unlike a sunburn. Although these effects can be severe, they are usually not permanent. The skin in this area may become permanently darker, however. Internal organs, bones, and other tissues can also be damaged. Internal radiation was developed to avoid these complications.
  
  
• You may feel very tired during radiation therapy.
  
  
• Radiation to the pelvis, as is needed for bladder cancer, can affect production of blood cells in the bone marrow. Common effects include extreme tiredness, increased susceptibility to infections, and easy bruising or bleeding.
  
  
• Radiation to the pelvis may also cause nausea, diarrhea, urinary problems, and sexual problems such as vaginal dryness in women and impotence in men.

Chemotherapy

Chemotherapy is the use of powerful drugs to kill cancer. In bladder cancer, chemotherapy may be given alone or with surgery or radiation therapy or both. It may be given before or after the other therapies. Chemotherapy can usually be given in the oncologist's office, but it may require a stay in the hospital.

• Stages Ta, T1, and CIS bladder cancer can be treated with intravesical chemotherapy. After removal of the tumor, one or more liquid drugs are introduced into the bladder via a thin, plastic tube called a catheter. The drugs remain in the bladder for several hours and are then drained out, commonly with urination. This treatment is typically repeated once a week for several weeks.
  
  
• Cancer that has invaded deeply into the bladder, lymph nodes, or other organs requires systemic or intravenous chemotherapy. The cancer-fighting drugs are injected into the bloodstream via a vein. This way, the drugs get into almost every part of the body and, ideally, kill cancer cells wherever they are.

Chemotherapy is well known for its unpleasant side effects. The side effects depend on which drugs you receive and how the drugs are given.

• The severity of side effects varies by person. For unknown reasons, some people tolerate chemotherapy much better than others.
  
  
• Some of the most common side effects of systemic chemotherapy include nausea and vomiting, loss of appetite, hair loss, sores on the inside of the mouth or in the digestive tract, feeling tired or lacking energy (because of anemia, that is, low red blood cell count), increased susceptibility to infection (because of low white blood cell count), and easy bruising or bleeding (because of low platelet count). Ask your oncologist about the specific effects you should expect.
  
  
• These side effects are almost always temporary and go away when chemotherapy is over.
  
  
• Multiple studies have demonstrated that intravesical chemotherapy is effective in decreasing the recurrence rate of superficial bladder cancers on a short-term basis.
  
  
• Intravesical chemotherapy, such as Mitomycin C, is often given as a single dose in the bladder immediately after the tumor has been removed with cystoscopy.
  
  
• Intravesical chemotherapy can irritate the bladder or kidneys.
  
  
• Intravesical chemotherapy is not effective against bladder cancer that has already penetrated into the muscular wall of the bladder or has spread to the lymph nodes or other organs.

Immunotherapy or Biological Therapy

Biological therapy takes advantage of the body's natural ability to fight cancer.

• Your immune system forms substances in the blood that work against "invaders," such as abnormal cells (that is, cancer cells).
  
  
• Sometimes, the immune system becomes overwhelmed by the very aggressive cancer cells.
  
  
• Biological therapy, or immunotherapy, helps bolster the immune system in its fight against the cancer.
  
  
• Biological therapy is typically given only in stages T_a, T₁, and CIS bladder cancers.
  
  
• One widely used immunotherapy or biological therapy in bladder cancer is intravesical BCG treatment.
  
  
• A fluid containing BCG, an attenuated vaccine (altered Mycobacterium), is introduced into the bladder through a thin catheter that has been passed through the urethra.
  
  
• The Mycobacterium in the fluid stimulates the immune system to produce cancer-fighting substances.
  
  
• The solution is held in the bladder for a few hours, then drained. This treatment is repeated every week for six weeks and repeated at various times over several months or even longer in some cases. Researchers are still working to determine the best length of time for these treatments. Over time, the treatments may be required on a less frequent basis.
  
  
• BCG may irritate the bladder and cause minor bleeding in the bladder. The bleeding is typically invisible in the urine. You may feel the need to urinate more often than usual or pain or burning when you urinate. Other side effects include nausea, low-grade fever, and chills. These are caused by stimulation of the immune system. These effects are almost always temporary.

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