Your treatment for bladder cancer will depend on whether you have non-invasive bladder cancer or invasive bladder cancer. You may be treated with surgery only or alongside chemotherapy and radiotherapy. Many of the treatments for bladder cancer involve injecting a chemotherapy dose directly into the bladder via a catheter. Your healthcare specialist, oncologist or surgeon will decide the best course of treatment for you.
Non-Invasive Bladder Cancer
Most early cancers will be treated with an operation to remove part of the bladder lining. Depending on the type and risk of return, you may then be treated with chemotherapy or the BCG vaccine direct into the bladder lining.
Surgery
Trans Urethral Removal Of Bladder Tumour (TURBT)
For non-invasive or early cancers you will usually be offered a minor surgical procedure to remove the affected part of your bladder lining. Your surgeon will remove the tumour by inserting a small flexible camera called a cystoscope through your urethra.
You may be offered a further TURBT procedure if you are considered at high risk of the tumour returning.
Chemotherapy Into The Bladder
Following your TURBT surgery, you may be offered a single dose or a short course of chemotherapy that is administered directly into your bladder via a catheter. You will probably be given one of three chemotherapy treatments.
- Mytomycin C
- Epirubicin
- Doxorubicin
You will be asked to hold the chemotherapy in your bladder for between 1 and 2 hours and then will be allowed to either release it in the normal way or a nurse will drain via the catheter. You will need to be careful not to let the chemotherapy drug come into contact with your skin.
BCG into the Bladder
BCG is primarily a vaccine that is used to prevent Tuberculosis (TB). It has also found to be effective at stopping or delaying bladder cancers from returning or spreading deeper into the bladder. It is not fully understood how this immunotherapy treatment works but it is thought that the vaccine activates the cells in your immune system to destroy any remaining cancer cells.
This treatment is administered direct into the bladder via a catheter. You may have an initial course for 6 weeks and then once every few month for 3 years.
Invasive Bladder Cancer/Locally Advanced Bladder Cancer
Surgery
If your bladder cancer is found to be invasive, you will be advised that it is best to have your bladder removed (a cystectomy). Your urine will need to be diverted now that your bladder has been removed. These are some of the options that your surgeon will talk to you about.
Urostomy (Ileal Conduit)
The most common urinary diversion after bladder removal is the creation of a urostomy or Ileal Conduit. This involves creating a stoma using a piece of your small bowel which will be attached to your ureters. This stoma will come through your abdomen and you will be required to wear a specially designed ostomy bag over your stoma to collect your urine. You can then empty your bag periodically throughout the day.
Continent Urinary Diversion
A continent urinary diversion is another option but can only be carried out by specialist surgeons and is not routinely offered due to the complexity of the operation.
During this operation a piece of your small bowel is used to create an internal pouch, a small opening is cut into your abdomen and the natural join between your small bowel and colon is attached to this hole. This is called a stoma. There is a natural valve that helps keep this closed which allows the urine to be stored internally. Unlike a urostomy, you will not need to wear a pouch over your stoma, you will need to insert a catheter through the stoma’s opening to release the urine several times a day.
Bladder Reconstruction
It is possible to have a bladder reconstruction but this type of surgery is not suitable for everyone. This will only be considered an option if:
- There is a very low chance of your cancer returning
- Your cancer did not affect your urethra
- You do not have any bowel problems such as Inflammatory Bowel Disease
A piece of your small bowel will be used to create a new bladder which will then be attached to your ureters and urethra. You won’t have the same nerve supply as you did before so your body will no longer tell you when you need to urinate. You will have to go at several intervals throughout the day to release the urine from your bladder. Some people may experience continence issues following this operation or will need to insert a catheter to drain the urine.
Recto Sigmoid Pouch
This involves turning your rectum into a pouch that works like a bladder. Your ureters will then be attached to the pouch and anal sphincter will be used to hold the urine in. You will then pass faeces and urine at the same time from your back passage. This type of procedure is only carried out if the cancer was close to or in your urethra.
Chemotherapy
Chemotherapy for invasive bladder cancer will be administered directly into your vein (intravenously) and you may require treatment over several months. The most common chemotherapy drugs for bladder cancer are listed below:
Gemcitabine may be combined with another chemotherapy drug such as Cisplatin which is known as Gemcis or combined with Carboplatin which is called GemCarbo.
Side Effects
You can find out the individual side effects of each drug by clicking on the links above. Some general side effects of chemotherapy include:
- Nausea and/or vomiting
- Fatigue
- Increased risk of infection
- Loss of appetite
- Bleeding and bruising easily
Radiotherapy
Radiotherapy may be offered to you instead of surgery. Not everyone is suitable for this treatment though, it will depend on how advanced your tumour is. Radiotherapy may also be combined with chemotherapy which is known as chemoradiation.
External Radiotherapy
This uses high dose x-rays to kill cancer cells. You are normally given a long course of treatment which can last up to 7 weeks. Your specialist will use a CT to plan and mark the areas to target. The treatment only lasts a few minutes but it will usually require you to have daily treatment for a number of days or weeks.
Your treatment for cancer is as individual as you and your team of specialists will be able to discuss your options so that you can make an informed decision and understand what to expect. For further information on bladder cancer you may like to look at the below sites:
- Cancer Research UK
- Macmillan Cancer Support
- Action Bladder Cancer UK
- The British Association of Urological Surgeons
Living with bladder cancer can affect you emotionally and socially; sometimes it can help to speak to others who understand your situation. The Bladder & Bowel Community Forum is available 24 hours today and will allow you to connect with those who share your condition. Start your own topic today or just follow one that interests you.
