Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Standard therapies for bladder cancer include surgery, radiationtherapy, 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 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
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
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.