Bladder Cancer (cont.)
Side effects of bladder cancer treatment
Because cancer treatment may damage healthy cells and tissues, unwanted side
effects sometimes occur. These side effects depend on many factors, including
the type and extent of the treatment. Side effects may not be the same for each
person, and they may even change from one treatment session to the next. Doctors
and nurses will explain the possible side effects of treatment and how they will
help the patient manage them.
The NCI provides helpful booklets about cancer treatments and coping with
side effects, such as Radiation Therapy and You, Chemotherapy and You, and
Eating Hints for Cancer Patients. See the "National Cancer Institute Information
Resources" and "National Cancer Institute Booklets" sections for other sources
of information about side effects.
Surgery
For a few days after TUR, patients may have some blood in their urine and
difficulty or pain when urinating. Otherwise, TUR generally causes few problems.
After cystectomy, most patients are uncomfortable during
the first few days. However, medicine can control the pain. Patients should feel
free to discuss pain relief with the doctor or nurse. Also, it is common to feel
tired or weak
for a while. The length of time it takes to recover from an operation varies for
each person.
After segmental cystectomy, patients may not be able to hold as much urine in
their bladder as they used to, and they may need to urinate more often. In most
cases, this problem is temporary, but some patients may have long-lasting
changes in how much urine they can hold.
If the surgeon removes the bladder, the patient needs a new way to store and
pass urine. 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 surgeon attaches
one end of the tube to the ureters and connects the other end to a new opening
in the wall of the abdomen. This opening is called a stoma. A flat bag fits over
the stoma to collect urine, and a special adhesive holds it in place. The
operation to create the stoma is called a urostomy or an ostomy.
For some patients, the doctor is able to use a part of the small intestine to
make a storage pouch (called a continent reservoir) inside the
body. Urine collects in the pouch instead of going into a bag. The surgeon
connects the pouch to the urethra or to a stoma. If the surgeon connects the
pouch to a stoma, the patient uses a catheter to drain the urine.
Bladder cancer surgery may affect a person's sexual function. Because the
surgeon removes the uterus and ovaries in a radical cystectomy, women are not
able to get pregnant. Also, menopause occurs at once. Hot flashes and other
symptoms of menopause caused by surgery may be more severe than those caused by
natural menopause. Many women take hormone replacement therapy
(HRT) to relieve
these problems. If the surgeon removes part of the vagina during a radical
cystectomy, sexual intercourse may be difficult.
In the past, nearly all men were impotent after radical cystectomy, but
improvements in surgery have made it possible for some men to avoid this
problem. Men who have had their prostate gland and seminal vesicles removed no
longer produce semen, so they have
dry orgasms. Men who wish to father children
may consider sperm banking before surgery or sperm retrieval later on.
It is natural for a patient to worry about the effects of bladder cancer
surgery on sexuality. Patients may want to talk with the doctor about possible
side effects and how long these side effects are likely to last. Whatever the
outlook, it may be helpful for patients and their partners to talk about their
feelings and help one another find ways to share intimacy during and after
treatment.
Radiation therapy
The side effects of radiation therapy 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.
External radiation may permanently darken or "bronze" the skin in the treated
area. Patients commonly lose hair in the treated area and their skin may become
red, dry, tender, and itchy. These problems are temporary, and the doctor can
suggest ways to relieve them.
Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or
urinary discomfort. The doctor can suggest medicines to ease these problems.
Radiation therapy also may cause a decrease in the number of white blood
cells, cells that help protect the body against infection. If the blood counts
are low, the doctor or nurse may suggest ways to avoid getting an infection.
Also, the patient may not get more radiation therapy until blood counts improve.
The doctor will check the patient's blood counts regularly and change the
treatment schedule if it is necessary.
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.
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 patient to patient.
Anticancer drugs that are placed in the bladder cause irritation, with some
discomfort or bleeding that lasts for a few days after treatment. Some drugs may
cause a rash when they come into contact with the skin or genitals.
Systemic chemotherapy affects rapidly dividing cells throughout the body,
including blood cells. Blood cells fight infection, help the blood to clot, and
carry oxygen to all parts of the body. When anticancer drugs damage blood cells,
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. To protect the kidneys, patients need a lot of fluid. The nurse may give
the patient fluids by vein before and after treatment. Also, the patient may
need to drink a lot of fluids during treatment with these drugs.
Certain anticancer drugs can also cause tingling in the fingers, ringing in
the ears, or hearing loss. These problems may go away after treatment stops.
Biological therapy
BCG therapy can irritate the bladder. Patients may feel an urgent need to
urinate, and may need to urinate frequently. Patients also may have pain,
especially when urinating. They may feel tired. Some patients may have blood in
their urine, nausea, a low-grade fever, or chills.
Nutrition
Patients need to eat well during cancer therapy. They need enough calories to
maintain a good weight and protein to keep up
strength. Good nutrition often
helps people with cancer feel better and have more energy.
But eating well can be difficult. Patients may not feel like eating if they
are uncomfortable or tired. Also, the side effects of treatment, such as poor
appetite, nausea, or vomiting, can be a problem. Foods may taste different.
The doctor, dietitian, or other health care provider can suggest ways to
maintain a healthy diet. Patients and their families may want to read the
National Cancer Institute booklet Eating Hints for Cancer Patients, which
contains many useful ideas and recipes. The "National Cancer Institute Booklets"
section tells how to get this publication.
Next: What happens after treatment for bladder cancer? »
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