Immunotherapy: Immunotherapy is a treatment that causes the body's own natural defenses (immune system) to attack the cancer. The treatment is placed directly into the bladder through a catheter rather than being given by mouth or injection.

This type of treatment is sometimes used for early or low stage bladder cancer that has high risk for returning (recurrence) or becoming more advanced disease (progression). A weakened bacterium called BCG is placed directly into the bladder. Immune system cells are attracted and activated by BCG, which in turn affects the bladder cancer cells. Treatments are given weekly for 6 weeks, and may be repeated, or used as preventative therapy (maintenance) using 3 weekly treatments every 6 months for a few years. Sometimes, a reduced dose of BCG is used with another immune-active agent called interferon, which causes fewer side effects, but maintains effectiveness against tumors that may have not responded to BCG alone.

The treatment may cause flu-like symptoms with low grade temperature, muscle aches, joint aches, as well as frequent urination or a burning sensation in the bladder. In rare instances, a high fever (over 101.5 degrees) that does not respond to aspirin or Tylenol could indicate a life-threatening spread of BCG infection into the blood stream. If that happens, you should call your doctor right away. Usually these infections can be treated with antibiotic drugs used to treat tuberculosis.

Chemotherapy: Chemotherapy is the use of anticancer drugs placed directly into the bladder (intravesical) or injected into a vein or given by mouth (systemic).

Chemotherapy placed directly into the bladder (intravesical) only reach cancer cells near the bladder lining rather than those in other organs or deep in the bladder wall.  This treatment is used only for early stage (superficial) bladder cancer. One of the main advantages of this method of chemotherapy is that the drug doesn't usually spread throughout the body. This means that there is less chance of unwanted side effects, but there can be local bladder irritation.

In systemic chemotherapy, the drugs travel through the bloodstream to all parts of the body. In this treatment, the drugs can attack cancer cells that have already spread beyond the bladder to lymph nodes and other organs. While chemotherapy drugs kill cancer cells, they also damage some normal cells and this can lead to side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment. You could experience some of these temporary side effects:

• Fatigue
• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores
• A higher risk of infection caused by a shortage of white blood cells
• Bruising or bleeding after minor cuts

There are many newer medications that minimize these side effects, such as increasing the white blood cell counts,or controlling nausea. Most of these side effects go away when treatment is over. If you have any problems with side effects, be sure to tell your doctor or nurse, as there are often ways to help.

Radiation Therapy: Radiation is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body. After surgery, radiation can kill small deposits of cancer cells that may not be seen during surgery.

After transurethral surgery a combination of radiation therapy and chemotherapy is sometimes able to completely destroy cancers that would otherwise require cystectomy. If the tumor is in a position that makes surgery difficult, radiation may be used to shrink the tumor, making surgery easier. Radiation might also be used to ease the symptoms of advanced cancer or limit bleeding from inoperable tumors.

Mild skin irritation, nausea, bladder irritation, diarrhea, or fatigue may occur after radiation therapy. These problems usually go away when treatment ends. If you have these or other side effects, you should talk to your doctor. Often there are ways to help.