Deciding what treatment is best for you can be difficult. Your doctor will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

The recommended treatment plan for invasive bladder cancer will depend on how far the cancer has spread.

Health professionals use a staging system to describe the spread of bladder cancer. The stages are outlined below.

• T2a – where the cancer has spread to the inner half of the muscles surrounding the bladder.
• T2b – where the cancer has spread to the outer half of the muscles.
• T3a – where the cancer has spread into the layer of fat surrounding the muscle, but can only be seen with a microscope.
• T3b – where the cancer has spread into the layer of fat surrounding the muscle and can be seen without using a microscope.
• T4a – where the cancer has spread beyond the bladder into near-by organs, such as the prostate, vagina, or womb.
• T4b – where the cancer has spread to the wall of the pelvis or abdomen.

In cases of T2, T3 and T4a bladder cancer, a cure may be possible using a combination of chemotherapy and radiotherapy, plus surgery to remove some, or all, of the bladder.

In cases of T4b bladder cancer, unfortunately the prospect for a cure is slim. However, it is possible to control the symptoms and slow the spread of the cancer using chemotherapy and radiotherapy and, in some cases, surgery.

Surgery

Surgery for invasive bladder cancer involves removing some, or all, of the bladder. This is known as a cystectomy.

Cystectomy

There are two types of cystectomy:

• a partial cystectomy – where only part of the bladder is removed, and
• a radical cystectomy – where all of the bladder is removed as well as near-by lymph nodes, part of the urethra, the prostate (in men), and the cervix and womb (in women).

A radical cystectomy carries the obvious drawback of the loss of normal bladder function. Further surgery will be required to compensate for the loss of bladder function by creating an alternative way for urine to leave your body. This type of surgery is known as urinary diversion.

Men also have the risk of not being able to get or maintain an erection (erectile dysfunction) after a radical cystectomy because the operation can sometimes damage the nerves that are responsible for this ability. However, treatments are available for erectile dysfunction.

More information about urinary diversion and erectile dysfunction is provided in the article on the complications of bladder cancer.

The main advantage of a radical cystectomy is that is has a greater track record of success in preventing the return of the cancer and extending life-span. Therefore, it is usually the treatment of choice for invasive bladder cancer.

An exception may be made in cases of T2a and T2b bladder cancer where there is only one tumour present in the bladder.

You should discuss the advantages and disadvantages of both techniques with your MDT before making a decision about your treatment.

Radiotherapy

Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancerous cells.

There are three main ways that radiotherapy can be used to treat bladder cancer which are explained below.

• Radiotherapy can be used before a cystectomy is carried out in an attempt to shrink the tumour(s) in order to increase the chances of the operation being successful.
• Radiotherapy can be used as a primary treatment to try to cure bladder cancer; this may be a preferred option if your general state of health is thought to be too poor to withstand the effects of a cystectomy.
• Radiotherapy can be used to help control symptoms in cases of incurable bladder cancer; this is known as palliative radiotherapy.

External radiotherapy

Radiotherapy that is used to shrink tumours and/or to achieve a cure is given by a machine that beams the radiation at the bladder. This is known as external radiotherapy.

Sessions of external radiotherapy for bladder cancer are usually given on a daily basis, for five days a week, over the course of 4-7 weeks. Each session of radiotherapy lasts about 10-15 minutes.

As well as destroying cancerous cells, radiotherapy can also damage healthy cells so it can cause a number of different side effects. These include:

• diarrhoea,
• an increased need to urinate,
• pain when urinating,
• tightening of the vagina (in women) which can make having sex difficulty and painful,
• erectile dysfunction (in men),
• loss of pubic hair, and
• infertility.

With the exception of infertility, these side effects should pass a few weeks after your treatment finishes. The fact that radiation has been directed at your pelvis usually means that you will be infertile for the rest of your life. If you still want to have children you should discuss possible treatment options with your MDT

For example, men can have samples of their sperm frozen and women can have their eggs frozen for use in future artificial insemination treatments such as IVF. However, this will not be possible if you are a woman and you have a radical cystectomy because your womb will be removed.

External radiotherapy will not make you radioactive, and you will pose no danger to other people, including children and pregnant women.

Palliative radiotherapy

Palliative radiotherapy is usually only given for a few minutes, so it will not usually cause side effects or, if there are any side effects, they will only last for a short time.

Chemotherapy

There are three main ways that chemotherapy can be used to treat invasive bladder cancer:

• it can be used before radiotherapy and surgery in order to shrink the size of any tumours,
• it can be used in combination with radiotherapy before surgery – this is known as chemoradiation, and
• it can be used to slow the spread of incurable, advanced bladder cancer.

As yet, there is not enough evidence to say whether chemotherapy is an effective treatment when it is given after surgery in order to prevent the return of the cancer.

Intravenous chemotherapy is used to treat invasive bladder cancer, which involves a combination of different chemotherapy medications being injected directly into your vein.

Chemotherapy is usually given for two days a week, for several weeks, and then you have a week off to allow your body to recover from the effects of the treatment. This cycle is then repeated.

A total course of chemotherapy can last for up to six months. As the chemotherapy medication is being injected into your blood, you will experience a wider range of side effects than if you were having intravesical chemotherapy.
The side effects of chemotherapy can include:

• nausea,
• vomiting,
• hair loss,
• lack of appetite, and
• tiredness.

You should immediately report any signs of your infection to your MDT – for example:

• if your temperature rises above 38C (100.5f), or
• you suddenly start to feel unwell.

Related posts:

1. Treatment for non-invasive bladder cancer
2. Bladder Cancer: Symptoms And Causes
3. Bladder Cancer: Diagnoses
4. Cervical cancer vaccine trial raises hope