Treatment decisions for bladder cancer

Making treatment decisions

You and your doctor decide together on the best treatment plan for you. Your doctor is an expert in bladder cancer treatments. But you know your preferences and what is important to you.

Doctors sometimes ask you to choose between different treatments. This is usually when 2 treatments work equally well.

It can help to talk to your family or friends about your treatment options. Your doctor or nurse can also help. You do not usually need to decide straight away.

You may also want to talk to other people who have had treatment. Your cancer doctor or nurse may know whether there is a local cancer support group, where you can talk to someone who has had similar treatment. Or you can visit our bladder cancer forum to talk with people affected by bladder cancer, share your experience, and ask questions.

You could write a list of benefits and disadvantages for each treatment. When choosing a treatment, you may want to think about:

how long you need to have it for
how it may affect your everyday life
how much time you will need to spend in hospital
the different side effects and how they are likely to affect you.

Your doctor or nurse may give you printed information or show you videos about your treatment options. They may also show you online tools to help you make your decision. These may be called decision-making aids. Depending on the treatments you are offered, the information below may also help.

Related pages

Help with making treatment decisions

BCG or cystectomy?

If you have high-risk, non-muscle-invasive bladder cancer, your doctor may talk with you about deciding between BCG treatment or surgery to remove the bladder. This is called a cystectomy.

Before suggesting you have a cystectomy, doctors consider other treatments that aim to keep the bladder. They look at the benefits of these treatments, compared to the risk of the cancer spreading.

Talking to your doctor or nurse can help you understand the benefits and any possible disadvantages of each treatment. Make sure you have the information you need. This will help you to feel more confident about making the right decision for you. You may also want to talk it over with a partner, family member or friend.

Cystectomy or radical radiotherapy?

The main treatments for muscle-invasive or locally advanced bladder cancer are:

surgery to remove the bladder – this is called a cystectomy
radical radiotherapy.

The aim of both treatments is to cure the cancer. They may both be effective. If you are asked to choose between them it may help to think about what each treatment involves and the different side effects.

Having the treatment

For a cystectomy, you will be in hospital for 4 to 14 days. You will have a general anaesthetic. You need to be well enough to cope with the operation. You will have tests on your heart and lungs before the operation. It may take 3 to 6 months to fully recover.

Radical radiotherapy is not usually as physically demanding as surgery. You will not have a general anaesthetic. You will travel to the hospital Monday to Friday, for 4 to 7 weeks for treatment. Often, radiotherapy is given with chemotherapy.

If the cancer comes back after radiotherapy, you may be able to have surgery to remove the bladder. But the effects of radiotherapy may make surgery more complicated. Your doctor can talk to you about this.
Effects on the bladder

A cystectomy removes the bladder. The surgeon makes a new way for you to pass urine (pee). This is called a urinary diversion. It takes time to get used to living with a urinary diversion.

Radiotherapy means you keep your bladder and pass urine in the same way as before treatment. You are likely to have bladder irritation during treatment. Some people will have permanent bladder side effects such as needing to pass urine more often or blood in the urine.
Effects on the bowel

Surgery sometimes causes bowel complications. But these usually get better with time.

Sometimes radiotherapy may cause permanent bowel symptoms such as ongoing loose stools (poo), diarrhoea or blood in the stools.
Effects on erections and sperm production

Both treatments can cause difficulties getting or keeping an erection. This is called erectile dysfunction or ED. But this is highly likely after cystectomy.

Both treatments can affect your ability to make someone pregnant. This is called your fertility.

Ask your cancer team to explain the risks of these side effects in your situation. It can depend on your age and the exact treatment you need.
Menopause and effects on the vagina

Both treatments can cause vaginal changes and may cause early menopause. Menopause means monthly periods will stop and it is no longer possible to get pregnant.

Vaginal changes can make penetrative sex or internal examinations more difficult. They may also change how sex feels.

Ask your cancer team to explain the risks in your situation. Sometimes your treatment can be given in a way that reduces the chance of these side effects.

Related pages

Bladder and bowel problems

Treatment decisions when bladder cancer cannot be cured

If bladder cancer cannot be cured, the aim of treatment is to:

control the cancer
help you live longer
improve symptoms.

This can mean you have different treatments depending on when you need them. You may have long periods between treatments when you feel well and can continue with daily life. You may have ongoing treatment to control the cancer.

Your doctor can often give advice about how well a treatment will work. You may decide to have one treatment instead of another because:

the side effects are different
it means you will spend less time at the hospital.

You may need to have a treatment for a while to see if it is helping. Doctors will try to avoid you having unnecessary side effects from a treatment that is not working well.

If it becomes difficult to control the cancer, you may decide not to have further treatment. Your doctor and nurse will support you and make sure your symptoms are managed.

We have more information on coping with advanced cancer.

About our information

References

Below is a sample of the sources used in our bladder cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Mottet N, Bellmunt J, Briers E, et al. Non-muscle-invasive bladder cancer (TaT1 and CIS). European Association of Urology (Internet), 2021. Available from uroweb.org/guideline/non-muscle-invasive-bladder-cancer (accessed September 2021).

Witjes JA, Bruins HM, Cathomas R, et al. Muscle-invasive and metastatic bladder cancer. European Association of Urology (Internet), 2021, Available from uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic (accessed September 2021).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.