Side effects of treatment for invasive bladder cancer

Major surgery/cystectomy

This is a very big operation and recovery usually takes about three months, although it may take a year to recover fully. Currently many people have a short course of chemotherapy for 6 weeks before the operation. They may experience disabling effects of treatment from the time chemotherapy is started. In addition to physical recovery the person has to learn how to manage their urostomy or their bladder reconstruction (they may need to catheterise themselves regularly to empty it). Psychological adjustment to having a urostomy may be difficult. It may take a long time to learn how to manage the urostomy successfully without leakage and if a bladder reconstruction has been performed there may be regular urinary incontinence to manage especially during the night. Click here for more details on Surgery

Radiotherapy

Radiotherapy to the bladder causes the general side effects of radiotherapy. Specific effects of radiotherapy to the bladder are:

• Pain on passing urine
• Frequency
• Bowel problems, often diarrhoea

When radiotherapy is given as the main treatment to get rid of the bladder cancer, the treatment itself takes about 6 weeks, the side effects can continue after it has finished. It is important for regular cystoscopies to be undertaken after radiotherapy to check that the cancer has not come back. These are done every six months for five years. If bladder cancer returns locally after radiotherapy then surgery with ‘salvage cystectomy’ is possible.

For most people symptoms should resolve once treatment is complete but symptoms such as frequency, blood in the urine or diarrhoea may return years later as a result of damage to the bladder and bowel by radiotherapy. The advantage of this treatment is it avoids major surgery and enables people with bladder cancer to have a continent bladder. If bladder cancer returns locally after radiotherapy then surgery is possible. Click here for more details on Radiotherapy

Chemotherapy

Chemotherapy given before surgery improves survival; this is called neoadjuvant chemotherapy and is usually given for six weeks before surgery. Click here for more details of Chemotherapy

The 5 year survival for invasive bladder cancer with treatment is less than 50%. Treatments are effective at removing local disease but metastases elsewhere in the body are common in the years after successful treatment. Recurrent bladder cancer after surgery, recurrent bladder cancer after radiotherapy where surgery is not possible and metastatic disease are in the advanced bladder cancer group in this guidance.

Amended June 2008