The two most common surgical procedures in bladder cancer are transurethral resection and cystectomy.

Transurethral resection (TUR): The surgeon inserts a cystoscope into the bladder through the urethra, making it unnecessary to cut into the abdomen. The doctor then removes the cancer using a tool with a small wire loop on the end or burns the tumor with high-energy electricity (fulguration). Side effects include mild bleeding and discomfort immediately following surgery.

Cystectomy: The doctor makes an incision in the abdomen, and then removes the whole bladder. In men the prostate and seminal vesicles are also taken out as well as part of the urethra. In women, the uterus, ovaries, fallopian tubes, urethra and part of the vagina are removed. The lymph nodes in the pelvis may also be taken out. In rare instances, a partial cystectomy (removal of only a section of the bladder) is possible if the cancer is small, present in only one area of the bladder and away from the ureters and urethra.

If the bladder is removed, the doctor will need to create a new way for the body to store and pass urine. A procedure called an ostomy or urostomy uses a section of the small intestine to pass urine through an opening (a stoma) to the outside of the body. To collect urine, the patient wears a special bag that adheres to the skin. The doctor can also create a storage pouch that sits inside the body (a continent reservoir) using a part of the small intestine. The patient then uses a catheter to drain the urine through the stoma. Side effects of an ostomy are wound infections, urine leaks and urine obstruction.

A stoma is not necessary with methods that use part of the small intestine to make a storage pouch connected to a remaining part of the urethra. The urethra can then empty the body of urine.

Urinary diversion: This operation creates a way for urine to pass out of the body other than the bladder. This procedure is used to relieve a patient's bladder symptoms if the tumor has spread. Side effects are wound infections, urine leaks and urine obstruction.

Radiation therapy consists of using high-energy X-rays many times more powerful than a normal chest X-ray to destroy the ability of cells to grow and divide. Radiation may come from a machine outside the body (external radiation therapy) focused on the cancer or from a local treatment using a small pellet of radioactive material placed inside or near the tumor (internal radiation therapy).

Doctors may use radiation to destroy small cancerous areas not removed during surgery. Radiation can be used before surgery to shrink a tumor if its size or location makes operating difficult. In addition, bladder cancer symptoms such as pain, bleeding or blockage may be relieved with radiation.

Side effects of radiation include patches of skin that appear sun-burnt in the area treated, fatigue, nausea, diarrhea, hair loss and stomach cramps.

Chemotherapy involves the use of anti-cancer drugs, taken orally or intravenously. These drugs destroy cancer cells by interfering with their growth or by preventing them from reproducing. Physicians may decide to use local (intravesicular) or whole body (systemic) treatment, depending on how much the cancer has spread.

For local treatment, drugs in a fluid form are placed into the bladder with a tube inserted through the urethra. These drugs fight cancer cells near the bladder lining but cannot reach cancer cells in other organs of the urinary tract such as the kidneys, ureters or urethra. In addition, local treatment will kill only superficial cells and cannot penetrate to treat tumor cells in the bladder wall or growths that have spread to other organs. Consequently, doctors will only use this therapy for superficial tumors, those that are limited to the bladder. Drugs used for intravesical chemotherapy include mitomycin, thiotepa and doxorubicin. Side effects are minimal; patients may experience irritation in the bladder.

Systemic chemotherapy is used when the cancer has spread to other organs or cannot be cured with surgery alone. In this form of therapy, drugs are taken orally or by injection. These drugs enter the bloodstream and travel to all parts of the body. Systemic chemotherapy can attack tumors that have spread beyond the bladder to lymph nodes and other organs.

A combination of drugs is the most effective option for systemic treatment of bladder cancer. Combinations frequently used are M-VAC [methotrexate, vinblastine, adriamycin (also called doxorubicin HCl) and cisplatin] or MCV (methotrexate, cisplatin and vinblastine). Other effective drugs are cyclophosphamide, gemcitabine and paclitaxel.

Side effects of systemic chemotherapy include damage to normal cells, nausea and vomiting, loss of appetite, loss of hair and mouth sores. The patient may have a low blood cell count because treatment can damage bone marrow. Low red blood cell counts can cause fatigue. A shortage of platelets can cause bleeding or bruising after minor injuries, and a shortage of white blood cells can increase the chance of infection. Medication can often reduce side effects and most disappear once treatment is complete.

Immunotherapy uses materials made by the body or in a laboratory to boost patients' natural defenses to attack the cancer. It is sometimes called biological therapy or biological response modifier (BRM) therapy.

Intravesical immunotherapy places materials into the bladder rather than giving them orally or through injection. To treat low-stage bladder cancer, the doctor may administer a bacterium called bacillus Calmette-Guerin (BCG) through a catheter. The patient's immune system cells are then attracted to the bladder to fight the tumor.

Side effects of this treatment include chills, mild fever, fatigue and a burning sensation in the bladder. Rarely, a fever of more than 101.5 degrees Fahrenheit that does not respond to an analgesic could indicate a life-threatening BCG infection. The patient should seek medical attention immediately.

The treatment for bladder cancer is determined by the stage of the disease.

Stage 0: Doctors may perform a transurethral resection with fulguration. Intravesical chemotherapy or intravesical immunotherapy can follow. A partial or radical cystectomy are rare at this stage, but might be considered if many superficial cancers exist or if they are spreading. A clinical trial of photodynamic therapy (see advances) or intravesical biological therapy are options. The five-year survival rate for Stage 0a cancer is better than 95 percent. The five-year survival rate for Stage 0 is about 85 percent because patients risk the spread of cancer to the muscle.

Stage I: In addition to procedures listed in Stage 0, doctors may decide to use internal or external radiation therapy. Clinical trials of chemotherapy to prevent recurrence or a trial of intravesical therapy may be recommended.

More than half of Stage I patients develop one or more new bladder cancers, and 20 to 30 percent will have a tumor that invades the bladder muscle. The five-year survival rate is 85 percent.

Stage II: A radical cystectomy, in addition to removing the lymph nodes in the pelvis, may be performed. Physicians may opt for external radiation therapy or internal radiation therapy before or after external treatment. Transurethral resection with fulguration or partial cystectomy are also options. Clinical trials may include neoadjuvant chemotherapy (treatment before surgery to improve overall results and to preserve the bladder) or adjuvant chemotherapy (treatment to kill cancer cells left behind after surgery) or chemotherapy plus radiation therapy. The five-year survival rate for patients with Stage II is 65 to 75 percent.

Stage III: Treatment options include those listed in Stage II, in addition to radiation plus chemotherapy. The five-year survival rate varies from 30 to 65 percent.

Stage IV: If the bladder cancer has spread to nearby tissue or lymph nodes, but not to other parts of the body, treatment may include a radical cystectomy, radiation therapy, a urinary diversion or a cystectomy to relieve symptoms. Physicians may use chemotherapy following one of these treatments. Clinical trials may also be recommended. The five-year survival rate is 10 to 15 percent.

If the cancer has spread to the lymph nodes or other sites far away from the bladder, treatment may include chemotherapy alone or in addition to surgery or radiation therapy, urinary diversion or cystectomy to reduce symptoms. A clinical trial of chemotherapy may be recommended.