It is hard to limit the effects of cancer therapy so that only cancer cells, not healthy cells, are removed or destroyed. Because treatment can damage healthy cells and tissues, it often causes side effects.

These side effects depend mainly on the type and extent of the cancer treatment. Also, the effects may not be the same for each person, and they may even change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment, and they can help relieve symptoms that may occur during and after treatment.

Surgery

TUR causes few problems. Patients may have some blood in their urine and difficulty or pain when urinating for a few days afterward.

After any bladder surgery, particularly radical cystectomy, patients are often uncomfortable during the first few days. However, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient.

After segmental cystectomy, patients may not be able to hold as much urine in their bladder. In most cases, this problem is temporary, but some patients may have long-lasting changes in bladder capacity.

When the bladder is removed, the patient needs a new way to store and pass urine. Various methods are used. In one common method, the surgeon uses a piece of the person's small intestine to form a new tube through which urine can pass. The ureters are attached to one end, and the other end is brought out through an opening in the wall of the abdomen. This new opening is called a stoma. A flat bag fits over the stoma to collect urine, and special adhesive holds it in place. The patient will be taught how to care for the stoma. The surgical procedure to create a stoma is called a urostomy or an ostomy. (See Rehabilitation.)

A newer method uses part of the small intestine to make a new storage pouch (called a continent reservoir) inside the body. Urine collects there instead of emptying into a bag. The pouch is connected either to a stoma or to the urethra. The patient learns to use a catheter to drain the urine through the stoma or the urethra.

Women who have had a radical cystectomy are not able to have children because their uterus has been removed. In addition, the vagina may be narrower or shallower, which may make sexual intercourse difficult.

In the past, nearly all men were impotent after radical cystectomy, but improvements in surgery have made it possible to prevent this side effect in some cases. However, men who have had their prostate and seminal vesicles removed no longer produce semen, so they do not ejaculate when they have an orgasm and are not able to father children.

Radiation Therapy

With radiation therapy, the side effects depend mainly on the treatment dose and the part of the body that is treated. Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

With external radiation, there may be permanent darkening or "bronzing" of the skin in the treated area. In addition, it is common to lose hair in the treated area and for the skin to become red, dry, tender, and itchy. These problems are temporary, and the doctor may be able to suggest ways to relieve them.

Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection. Usually, the doctor can suggest certain diet changes or medicine to ease these problems. For both men and women, radiation treatment for bladder cancer can affect sexuality. Women may experience vaginal dryness, and men may have difficulty with erections.

Although the side effects of radiation therapy can be distressing, the doctor can usually treat or control them. It also helps to know that, in most cases, side effects are not permanent. The National Cancer Institute booklet Radiation Therapy and You has helpful information about radiation therapy and managing its side effects.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives as well as how the drugs are given. In addition, as with other types of treatment, side effects vary from person to person.

Anticancer drugs that are placed in the bladder may irritate the bladder for a few days after treatment, causing some discomfort or bleeding. Some drugs, if they come into contact with the skin or genitals, may cause a rash.

Systemic chemotherapy affects rapidly dividing cells throughout the body. These cells include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over. Certain drugs used in the treatment of bladder cancer also may cause kidney damage. Patients are given large amounts of fluid while taking these drugs. Anticancer drugs can also cause tingling in the fingers, ringing in the ears, or hearing loss. These problems may not clear up after treatment stops. The National Cancer Institute booklet Chemotherapy and You has helpful information about chemotherapy and coping with side effects.

Biological Therapy

Treatment with BCG can irritate the bladder for a few days after treatment. This may cause pain, especially while urinating, and the feeling of an urgent need to urinate. Patients also may have some blood in their urine, have a low fever, or feel tired or nauseated.

Other types of biological therapy may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a rash, or have swelling. These problems can be severe, but they go away after the treatment stops.