What Are Bladder Cancer Treatments? What Specialists Treat Bladder Cancer?
Although medical treatments are fairly standardized, different doctors have different philosophies and practices in caring for their patients. If bladder cancer is suspected or is a possible concern of your primary care doctor or internists then they may refer you to a urologist. Urologists are surgeons who specialize in the management of disorders of the urinary system. When selecting your urologist, you will want to identify someone skilled in treating bladder cancer and with whom you feel comfortable.
- You may want to talk to more than one urologist to find the one with whom you feel most comfortable. Clinical experience in treating bladder cancer is of the utmost importance.
- A urologist may also recommend or involve other specialists in your care either for their opinions or assistance in treating you. These specialists may be radiation oncologists and/or medical oncologists.
- Talk to family members, friends, and your healthcare provider to get referrals. Many communities, medical societies, and cancer centers offer telephone or Internet referral services.
After you have chosen a urologist to treat your cancer, you will have ample opportunity to ask questions and discuss the treatments available to you.
- Your doctor will describe each type of treatment, give you the pros and cons, and make recommendations based on published treatment guidelines and his or her own experience.
- Treatment for bladder cancer depends on the type of cancer and its stage. Factors such as your age, your overall health, and whether you have already been treated for cancer before are included in the treatment decision-making process.
- The decision of which treatment to pursue is made after discussions with your doctor (with input from other members of your care team) and your family members, but the decision is ultimately yours.
- Be certain you understand exactly what will be done and why, and what you can expect from your choices. With bladder cancer, understanding the side effects of treatment is especially important.
Other physicians that you may meet include a medical oncologist, a medical doctor specializing in the treatment of cancer, and a radiation oncologist, a specialized cancer doctor who treats cancer with radiation-based treatments.
Like all cancers, bladder cancer is most likely to be cured if it is diagnosed early and treated promptly.
- The type of therapy you receive will vary with the stage and grade of the bladder cancer and your overall health.
- For lower-grade and stage tumors, less invasive options such as treatments placed directly into the bladder referred to as intravesical therapy may be an option.
- For more invasive cancers, surgical therapies, radiation, and chemotherapy are options, depending on the extent of cancer and your overall health
Your treatment team will also include one or more nurses, a dietitian, a social worker, and other professionals as needed.
Standard therapies for bladder cancer include surgery, radiation therapy, chemotherapy, and immunotherapy or biological therapy.
- Surgery and radiation therapy are comparatively local therapies. This means that they get rid of cancer cells only in the treated area. The bladder itself may be treated or the surgery and/or radiation may be extended to adjacent structures in the pelvic region.
- Chemotherapy is a systemic therapy. This means that it can kill cancer cells almost anywhere in the body.
- Immunotherapy is also local therapy and involves a treatment placed into the bladder.
Radiation is a painless, invisible high-energy ray that can kill both cancer cells and normal cells in its path. New radiation treatments can focus radiation better and damage fewer normal cells. Radiation may be given for small muscle-invasive bladder cancers. It is commonly used as an alternative approach to or in addition to surgery, often in patients who may be too ill to undergo surgery. Either of two types of radiation can be used. However, for the 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 into short treatments given five days a week for 5 to 7 weeks. Spreading it out this way helps protect the surrounding healthy tissues by lowering the dose of each treatment. In addition, as cells are more sensitive to radiation during different phases in cell growth, and cancer cells are typically faster growing than normal cells, the use of frequent dosing is designed to kill cancer cells more readily and decrease the risk of killing normal cells. External radiation is given at the hospital or medical center. You come to the center each day as an outpatient to receive your radiation therapy.
- Internal radiation is given by many different techniques. One involves 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 if the radiation cannot be focused enough. 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 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 complications.
- You may feel very tired during radiation therapy.
- Radiation to the pelvis, as is needed for bladder cancer, can affect the 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, and rectal irritation leading to changes in bowel movements, and blood in the stool as well as urinary problems, and sexual problems such as vaginal dryness in women and impotence in men. Such problems arise shortly after treatment begins, or may appear sometime after radiation treatments are completed.