Like many people with cancer, you may choose to take an active role in the decisions affecting your medical care. If so, try to learn as much as you can about bladder cancer and the treatment options that exist. As part of this process, you may want to consider getting a second opinion from a bladder cancer specialist, such as an urologist, medical oncologist or urologic oncologist.

In many cases, your primary care doctor may refer you to one or more specialists. You can also get the names of specialists from a nearby hospital or medical school. Or, contact the Cancer Information Service at (800) 4-CANCER, or (800) 422-6237, to find out information about cancer centers and programs supported by the National Cancer Institute.

Ultimately, the best treatment for you will depend on a number of factors, including the type and extent of bladder cancer you have, as well as on your age, overall health and personal preferences. Below are some of the treatment options:

Surgical procedures

Surgical treatments are usually the best option for people with bladder cancer. The most common procedures include:

—      Transurethral resection (TUR). This is often used to treat superficial bladder cancer. During TUR, your doctor inserts a cystoscope — an instrument with a special lens and fiber-optic lighting system — into your bladder through your urethra. The cancer is removed with a small wire loop and any remaining cells are burned away with an electric current. In some cases, a high-energy laser may be used instead of the electric current. TUR itself causes few problems. You’re likely to have some blood in your urine or pain when you urinate for a few days following the procedure. But because superficial bladder cancer commonly recurs, you’ll need to see your doctor for a cystoscopic exam every three to six months.

—      Segmental cystectomy. This procedure may be an option when a tumor has invaded just one part of the bladder wall. It removes only the portion of the bladder that contains cancer cells. To remove the tumor, the surgeon makes an incision in your abdomen. General anesthesia is used, and you usually stay in the hospital for a week to 10 days. The main side effect of this surgery is more frequent urination. Although the problem is often temporary, it may become permanent in some people.

—      Radical cystectomy. Doctors may use this extensive operation for invasive bladder cancer or for superficial cancer that affects a large portion of the bladder. It involves removing the entire bladder, as well as nearby lymph nodes and part of the urethra. In men, the prostate gland, seminal vesicles — which produce some of the fluid in semen — and a portion of the vas deferens (a conduit for sperm) also are removed. For women, radical cystectomy usually means removing the ovaries, fallopian tubes and part of the vagina.

After a radical cystectomy, your surgeon may construct a new bladder for you or attach a pouch — either internally or externally — to collect urine.

Radical cystectomy can be life altering, affecting not only your ability to urinate normally but also your sexuality. Women who lose their ovaries and fallopian tubes are no longer able to become pregnant and enter menopause immediately. In addition, removing part of the vagina during surgery can affect the ability to have sexual intercourse.

In the past, the vast majority of men became impotent after a radical cystectomy. Now, new surgical procedures may prevent this problem in a very select group of men. Still, removing the prostate gland and seminal vesicles means that semen is no longer produced and sperm aren’t released during ejaculation. Bladder cancer usually occurs in men after the years of active reproduction, but some men who have a cystectomy early in life choose to bank their sperm before surgery. Others may later decide on a procedure in which sperm are removed from their testicles.

Radiation therapy

This therapy uses high-energy X-rays to destroy cancer cells and shrink tumors. It’s most often used after an operation to eliminate any remaining cancer cells. When surgical treatment isn’t an option, radiation may sometimes be used instead, but it’s much less effective than surgery.

In treating bladder cancer, radiation may either come from outside your body (external radiation) or from radioactive materials placed directly into your bladder (internal radiation).

External radiation is usually performed as an outpatient procedure, with treatments occurring five days a week for five to seven weeks.

You may find that you become tired during radiation therapy, especially during the last weeks of treatment. External radiation can also cause your skin to become red, tender and itchy — just as if you had sunburn. Women may also experience vaginal dryness, and men may have problems with impotence. Radiation may also cause bladder or bowel incontinence, impotence in men and irritation of the rectum, leading to diarrhea. These side effects are usually temporary. In the meantime, your doctor may be able to offer measures to make them more manageable.

Chemotherapy

This treatment uses drugs to destroy cancer cells. Your doctor may suggest having chemotherapy after an operation to eliminate any remaining traces of cancer, but sometimes you may have it before a surgical procedure in an effort to spare your bladder.

In most cases, two or more drugs are used in combination. They sometimes may be inserted directly into your bladder through your urethra — a procedure known as intravesical therapy. This treatment is commonly used after TUR to help prevent a very superficial cancer from recurring. You are likely to have intravesical therapy once a week for several weeks.

This isn’t an option if cancer cells have penetrated deep into the bladder wall or spread to other organs. In that case, chemotherapy drugs are given intravenously so that they travel through your bloodstream to every part of your body (systemic chemotherapy). This treatment is given in several cycles, which gives your body a chance to recover between sessions.

Even so, the side effects of chemotherapy — hair loss, nausea, vomiting and fatigue — can be severe. They occur because chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow — as well as cancerous ones. Not everyone has these side effects, however, and there are now better ways to control them if you do.

Systemic chemotherapy may also reduce the number of white and red blood cells in your body, making you temporarily more prone to infections and bruising. In addition, some drugs used to treat bladder cancer may cause kidney damage. To help prevent kidney problems, you may be given intravenous fluids during your treatment and advised to drink lots of fluids.

Biological therapy

Biological therapy stimulates your body’s own immune system to fight cancer. It’s usually used after TUR to help prevent superficial bladder cancer from recurring. Bacille Calmette-Guerin (BCG), a bacterium used in vaccines against tuberculosis, is the most commonly used immune stimulant. It binds to your bladder, where it triggers a response that inhibits the formation and growth of tumors. BCG is administered directly into your bladder using a small, flexible tube (catheter) for two hours once a week. Treatment may last six or more weeks.

During treatment with BCG, you may have some bladder irritation or blood in your urine and feel as if you have the flu. Your doctor may suggest a medication to help reduce some of these signs and symptoms. If you have a persistent high fever — greater than 101.5 F — that doesn’t respond to pain relievers, see your doctor promptly for treatment. This may indicate widespread infection of BCG, which can be serious.

Other treatments

Standard therapies for bladder cancer may not always be effective, or you may not be able to tolerate the side effects. In that case, several other treatments may be an option. One such option is photodynamic therapy (PDT).

This two-part treatment helps destroy bladder cancer cells. Initially you receive an injection of a chemical that is taken up by cancer cells but not by healthy ones. The cells containing the chemical are then exposed to light from a laser, which kills or severely damages them.

PDT may produce serious side effects, such as chronic bladder infections, bladder shrinkage and long-term sensitivity to sunlight. While promising, this therapy is only done at a limited number of centers and needs further study before it can be routinely recommended.

Bladder reconstruction

In radical cystectomy, your bladder is completely removed. Immediately afterward, your surgeon reconstructs your urinary system so that you can eliminate urine effectively. Several options for bladder reconstruction exist. The best approach for you depends on a number of factors, including your overall health and the extent to which the cancer has spread. In all cases, the goal is to maintain your quality of life as much as possible. Some reconstructive procedures include:

—      Urinary conduit. This is the simplest operation with the least risk of complications. It involves isolating a segment of your small intestine and attaching one end of it to your ureters. The other end is connected to an opening (stoma) in your lower abdomen through which urine drains into a small bag. You wear the bag outside your body and empty it three or four times a day. In the evening you can use a larger bag that allows you to sleep through the night.

—      Catheterizable stoma. This type of reconstruction eliminates the need for a bag. Instead, your surgeon fashions an interior pouch capable of holding 3 to 4 cups of urine. You drain the urine from the pouch several times a day using a catheter. Because the size of the pouch remains the same, you must also drain your urine during the night.

—      Neobladder. During this complex reconstructive procedure, your surgeon literally recreates a bladder. This is accomplished by connecting the same type of internal pouch used in a catheterizable stoma to the tube that carries urine from your body (urethra). As a result, you’re able to eliminate urine without having an external opening, although you may need to use a catheter inserted through your urethra. Neobladder reconstruction isn’t an option if some or all of your urethra has been removed, and it may lead to a number of complications, including scarring, internal urine leakage and incontinence.

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