Treatment for invasive bladder cancer

Surgery or radiotherapy

Surgery or radiotherapy may be used to treat invasive bladder cancers.

Surgery  Part, or all of the bladder may need to be removed. If the whole bladder is removed, you may need to have a new bladder made.

Radiotherapy may be used instead of surgery to try to avoid having to remove the bladder.

Some people may be offered a choice of having surgery or radiotherapy, because in some situations each treatment has the same chance of curing the cancer, but the benefits and disadvantages of the treatments are different:

Benefits and disadvantages of treatments for invasive bladder cancer

Surgery (total cystectomy)

• Benefits:
• The cancer may be completely cured
• Does not involve radiation, so avoids the side effects of radiotherapy, e.g. diarrhoea and cystitis
• Disadvantages:
• Need 7-14 days in hospital for operation and up to 6 weeks recovery time
• Needs an anaesthetic
• Need to wear a urostomy bag, learn to self-catherterise or learn to pass urine again
• Tiredness after operation
• High risk of impotence in men
• Risk of death related to surgery (2 in 100)

Radiotherapy

• Benefits:
• Does not involve an operation
• No anaesthetic needed
• After treatment it is possible to pass urine normally
• Disadvantages:
• Need to attend hospital each weekday for 4-7 weeks for treatment
• Tiredness during and after treatment (may last some months)
• Diarrhoea may occur and cystitis is common during treatment (approximately 70%)
• Possible long-term damage to bladder and rectum (2-5%)
• Risk of impotence in men

Giving consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give it. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

People often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, immediately so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.