Bladder Cancer (cont.)

Second Opinion

Before starting treatment, you may want a second opinion about your diagnosis, the stage of cancer, and the treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.

If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, or a nearby hospital or medical school for names of specialists.

Also, you can get information about treatment centers near you from NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) or LiveHelp (http://www.cancer.gov/livehelp).

Rehabilitation

Your health care team will help you return to normal activities as soon as possible. The goals of rehabilitation depend on the extent of disease and surgery.

If the surgeon removes your bladder, you'll need a new way to store urine. After your bladder is removed, the surgeon uses a piece of your small intestine or large intestine to make a new path for urine to exit the body or be stored. With this piece of intestine, the surgeon can either make a tube that carries urine from the ureters to the outside of the body or create a new bladder that holds urine inside the body.

Your health care team can tell you more about the following options:

  • Bag worn outside your body under your clothing: The surgeon can attach a small piece of intestine to the ureters and to a stoma (an opening in the wall of the abdomen). Urine drains from the ureters through the piece of intestine to the stoma. A flat bag fits over the stoma to collect urine, and special glue holds the bag in place. The bag is emptied several times a day.


  • New bladder or pouch inside your body: The surgeon can create a new bladder or pouch made from a piece of your intestine. The surgeon connects the pouch to the ureters so that urine can flow from the ureters and can be stored in the pouch in the pelvis. The surgeon also connects the pouch either to your urethra or to a stoma in the wall of your abdomen:


    • New bladder connected to your urethra: Because the pouch is joined to your urethra, you will be able to empty your new bladder much as you did before.


    • New bladder connected to a stoma: The surgeon creates a new path for urine to leave your body. The pouch is joined to the stoma, and you will use a catheter (a soft tube) to empty your bladder several times a day. You will not need to wear a bag over the stoma.


    At first, you will empty your bladder every two or three hours. But later on, you should be able to hold the urine for four to six hours.

A wound, ostomy and continence nurse or another member of your health care team will visit you before surgery to describe what to expect. The nurse or doctor will teach you how to care for yourself after surgery. If you need an ostomy, the nurse or doctor will help you decide where the opening should be on your abdomen and will teach you how to care for the stoma after surgery.

Ask your health care team about your physical, emotional, or sexual concerns. Often they can provide information about resources and support groups.

Nutrition

It's important for you to take very good care of yourself before, during, and after cancer treatment. Taking care of yourself includes eating well so you get the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth blisters) can make it hard to eat well.

Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs.


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