Bladder Cancer

Topic Overview

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 being exposed to certain chemicals or cigarette smoking raises your risk. And like other cancers, changes in the DNA of your cells seem to play a role. Also, when the lining of the bladder is irritated for a long time, cell changes that lead to cancer may occur. Some things that cause this are radiation treatment, having catheters in place for a long time, or having the parasite that causes schistosomiasis.

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 any cancer. Sometimes lasers or other methods can be used to get rid of tumors.
Chemotherapy , which uses medicine to destroy cancer cells.
Immunotherapy , which causes your body's natural defense system to attack bladder cancer cells.
Radiation therapy , which uses high-dose X-rays to kill cancer cells.

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.

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 factors for bladder cancer include:

Smoking. Cigarette smokers are much more likely than other people to get bladder cancer.
Being older than 40, being male, or being white (Caucasian).
Being exposed to cancer-causing chemicals, such as those used in the wood, rubber, and textile industries.
What you eat. A diet high in fried meats and fats increases your risk for bladder cancer.
Parasites. There is a parasite that causes schistosomiasis, which can increase your risk. This condition is sometimes found in developing countries and rarely occurs in North America.

Frequently Asked Questions

Learning about bladder cancer:	What is bladder cancer? What causes it? What are the symptoms? What increases my chances of getting bladder cancer? Who gets bladder cancer?
Being diagnosed:	How is bladder cancer diagnosed? What are the stages of bladder cancer?
Getting treatment:	How is bladder cancer treated? Will I need surgery? What is a transurethral resection (TUR)? What is a cystectomy? Will I need to take medicine? Will I need radiation treatment? Will I need immunotherapy? What are clinical trials?
Ongoing concerns:	What happens if my bladder cancer comes back?
Living with bladder cancer:	When should I call my doctor? What can I do at home to manage the side effects of treatment?
End-of-life issues:	How can I prepare for end-of-life issues? What is hospice care?

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	Cancer: Controlling nausea and vomiting from chemotherapy

Cause

The cause of bladder cancer is not known. Changes in the genetic material ( DNA ) of bladder cells may play a role. Chemicals in the environment and cigarette smoking also may play a role. And when the lining of the bladder is irritated for a long time, cell changes that lead to cancer may occur. Some things that cause this are radiation treatment, having catheters in place for a long time, or having the parasite that causes schistosomiasis.

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.

Symptoms

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.
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.

What Happens

Bladder cancer is the rapid, uncontrolled growth of abnormal cells in the bladder. Cancer usually begins in the lining of the bladder. 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 doctor finds out 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 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 about 74% of bladder cancers are diagnosed at this early stage.² Survival 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.

What Increases Your Risk

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 higher risk compared to nonsmokers, but the risk is significantly less than it is for cigarette smokers.
Being older. Your risk goes up as you get older, and most people who get bladder cancer are close to their 70s.
Being male. Men are 3 to 4 times more likely than women to develop bladder cancer.
DNA changes. These changes, which can be inherited or develop in your body on their own, can cause cells to grow too quickly or can keep cells from dying.
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.³
Chemical exposure. Bladder cancer has been linked to chemicals called aromatic amines that are found in many products, including dyes, paints, solvents, inks, and the dust from leather. This risk may also depend on how much and how often a person was exposed to these chemicals.
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.

When To Call a Doctor

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

Call your doctor 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 doctor. 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:

Doctors who can manage your cancer treatment include:

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

Exams and Tests

To find out whether bladder cancer may be the cause of your urinary symptoms, your doctor 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 check for 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 (cystoscope). Small tissue samples ( biopsies ) of any abnormal areas are taken and looked at under a microscope to find out whether cancer cells are present and what the cells look like (grade). Information from the biopsy, cystoscopy, and sometimes other tests is used to find out 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 find out if 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.

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 bone scan may be done to find out 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 exams 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.² More research is being done on these screening methods because they are not as accurate as a cystoscopy at this time.⁴

Treatment Overview

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 doctor 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 about 74% of bladder cancers are diagnosed at this early stage.²

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.⁵
Chemotherapy to destroy cancer cells using medicines. 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.
Immunotherapy . This therapy causes your body's natural defenses, known as your immune system , to attack bladder cancer cells.

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 cystoscopy .
Transurethral resection (TUR) is used to remove large early-stage 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 medicines to destroy cancer cells. For early-stage bladder cancer, the medicines 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 medicines used and your age and overall health. For some people, depending on the stage of the cancer, chemotherapy given before cystectomy ( neoadjuvant ) leads to better results.⁶

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.

Immunotherapy uses medicines that cause your body's immune system to attack bladder cancer cells. Bacillus Calmette-Guerin (BCG) and interferon are two of the medicines used for immunotherapy. Immunotherapy is most often used for early-stage 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 feel 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 doctor. 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, more than 90% of people live at least 5 years after they are diagnosed. The long-term outcome (prognosis) for men older than 65, African Americans, and those who smoke is worse than for other people who have bladder cancer.

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:

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:

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 exams 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.

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:

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 doctor. 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 doctor 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. 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 performs 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.

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 from 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:

Prevention

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

Cigarette smokers are much more likely to develop bladder cancer than nonsmokers. For help on how to quit smoking, see the topic Quitting Smoking.
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/or 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 Weight Management.
- Avoid dehydration . Increase your fluid intake, particularly water. Water dilutes cancer-causing chemicals.

Home Treatment

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 doctor has given you instructions or medicines 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 doctor before using any nonprescription medicines 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 first talking to your doctor.

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 caffeine late in the day.
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. Sexuality 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.

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 go through 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 doctor. Your doctor may also be able to refer you to groups that can offer 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 doctor has given you instructions or medicines 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 with your doctor any home treatment you use for pain.

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:

Medications

Medicines may be used to control the growth of bladder cancer cells and to relieve symptoms. Chemotherapy uses medicines to destroy cancer cells. Immunotherapy uses medicine that causes your body's immune response to attack cancer cells in your bladder.

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.

Medicines 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 medicines. 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 medicine. Epirubicin and valrubicin are also anthracycline antibiotics that may be used.
Paclitaxel or carboplatin are antitumor medicines that slow or stop the growth of cancer cells in the body.

Medicines 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 immunotherapy .
Mitomycin 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

Medicines, 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 doctor has given you instructions or medicines 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 are research studies to look for ways to improve treatments for bladder cancer. Experts are doing studies on:

Chemoprevention for early-stage bladder cancer. This is the use of medicines or vitamins to reduce the risk of getting cancer or having cancer come back.
Photodynamic therapy. This uses medicine and a special light to treat the cancer.
Chemotherapy before surgery. This is used for late-stage cancer.
How to keep the bladder working while people get chemotherapy or radiation.

Ask your doctor about taking part in a clinical trial.

Surgery

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 and the surrounding pelvic organs.

Following surgery to remove the bladder, your surgeon will create a new channel for urine to pass from your body.⁷

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. 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.

Other Treatment

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. Internal radiation uses needles, seeds, wires, or catheters that contain radioactive materials placed close to or directly into the bladder. Which treatment you receive will depend on the type and stage of your cancer.

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 noninvasive bladder cancer.^2, ⁸ Until all the drug is out of the body, the skin can get a sort of sunburn after even short exposures to light. This effect can last several weeks.⁹

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 taking part 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 take part 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.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone:	1-800-ACS-2345 (1-800-227-2345)
TDD:	1-866-228-4327 toll-free
Web Address:	www.cancer.org

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.

National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:	1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:	1-800-332-8615
E-mail:	cancergovstaff@mail.nih.gov
Web Address:	www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.

UrologyHealth.org, American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090
Phone:	1-866-RING AUA (1-866-746-4282) toll-free (U.S. only) (410) 689-3700
Fax:	(410) 689-3800
E-mail:	auafoundation@auafoundation.org
Web Address:	www.urologyhealth.org

UrologyHealth.org is a Web site written by urologists for patients. Visitors can find specific topics by using the "search" option. The Web site provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology Resource Center to find materials about urologic problems.

Related Information

Urinary Tract Infections in Teens and Adults

References

Citations

American Cancer Society (2009). Cancer Facts and Figures 2009. Atlanta: American Cancer Society. Available online: http://www.cancer.org/downloads/STT/500809web.pdf.

American Cancer Society (2009). American Cancer Society's Detailed Guide: Bladder Cancer. Available online: http://documents.cancer.org/126.00/126.00.pdf.

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.

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.

American Cancer Society (2007). Cancer Facts and Figures 2007, pp. 1–52. Atlanta: American Cancer Society. Available online: http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf.

National Comprehensive Cancer Network (2009). Bladder cancer. NCCN Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf.

McDougal WS, et al. (2008). Cancer of the bladder, ureter, and renal pelvis. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1358–1384. Philadelphia: Lippincott Williams and Wilkins.

Nieh PT, Marshall FF (2007). Surgery of bladder cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2479–2505. Philadelphia: Saunders Elsevier.

American Cancer Society (2008). Making treatment decisions: Lasers in cancer treatment. Available online: http://www.cancer.org/docroot/ETO/content/ETO_1_2x_Lasers_In_Cancer_Treatment.asp.

Other Works Consulted

American Cancer Society (2009). Cancer Facts and Figures 2009. Atlanta: American Cancer Society. Available online: http://www.cancer.org/downloads/STT/500809web.pdf.

American Urological Association (2007). Bladder Cancer: Guidelines for the Management of Nonmuscle Invasive Bladder Cancer (Stages Ta, T1, and Tis): 2007 Update, Chap. 3. Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bc.

Messing EM (2007). Urothelial tumors of the bladder. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2407–2446. Philadelphia: Saunders Elsevier.

Rosenberg JE, et al. (2008). Bladder. In AH Ko et al., eds., Everyone's Guide to Cancer Therapy: How Cancer is Diagnosed, Treated, and Managed Day to Day, 5th ed., pp. 447–458. Kansas City, MO: Andrews McMeel.

Credits

Author	Bets Davis, MFA
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Christopher G. Wood, MD, FACS - Urology/Oncology
Last Updated	May 13, 2009