Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Bladder Health after Cancer Treatment
Certain types of cancer and certain cancer treatments can cause damage to the urinary bladder. The information in thisHealth Link will help you to recognize signs and symptoms of urinary bladder problems that may occur after treatment
with chemotherapy or radiation for childhood cancer.
What is the urinary bladder?
The urinary bladder is a hollow organ that stores urine. It is locatedbehind the pubic bone. The kidneys filter the blood and make urine,
which enters the bladder through two tubes called “ureters.” Urine
leaves the bladder through another tube, the urethra.
What are the risk factors for bladder problems?
•Chemotherapy with cyclophosphamide and/or ifosfamide•

Radiation therapy to the pelvic area•

Surgery to the pelvic area

What types of bladder problems can occur?
• Difficulty voiding or incompletely emptying the bladder•

Bleeding into the bladder (hemorrhagic cystitis)•Scarring (fibrosis) of the bladder•

Bladder cancer•

Neurogenic bladder (see related Health Link: Neurogenic bladder after Cancer Treatment)

Hemorrhagic cystitis•What is hemorrhagic cystitis? Hemorrhagic cystitis is a condition in which bladder irritation results in blood inthe urine.

•What are the symptoms of hemorrhagic cystitis? The urine color may range from slightly pink to bright red.
Some people may feel like they have to urinate urgently, or that they cannot release all the urine, but there isusually no pain. Hemorrhagic cystitis may occur off and on for months to years after completion of therapy.

•

How is hemorrhagic cystitis diagnosed? Usually, blood can be seen in the urine. Sometimes, the amount ofblood in the urine is so small that it is seen only during a urinalysis (lab test to examine the urine). When there isblood in the urine, a urine culture is usually done to check for infection.

•What can I do if I have hemorrhagic cystitis? Usually it is helpful to drink extra fluids to flush out the bladder.
Avoid tea, coffee, cola beverages, and other fluids containing caffeine since they may worsen the sudden urge tourinate. If you have kidney or heart problems, check with your healthcare provider before drinking extra fluid.

•When should I call my healthcare provider? Call your healthcare provider any time you see blood in theurine. You should also report any fever, pain with urination, difficulty urinating, or the need to urinate urgently orfrequently, because these are common symptoms of a urinary tract infection or other bladder problems.

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Healthy living after treatment of childhood, adolescent, and young adult cancer

Bladder fibrosis•What is bladder fibrosis? Bladder fibrosis is scar tissue in the bladder. This may build up and cause the bladderwall to thicken. When this happens, the pressure inside the bladder increases. This may affect the bladder’sability to store and empty urine. Over time these changes can lead to damage to the kidneys.

•What are the symptoms of bladder fibrosis? Problems may include difficulty emptying the bladder, leakage ofurine, or blood in the urine. Sometimes, bladder fibrosis may not cause any symptoms at all.

•How is bladder fibrosis diagnosed? An ultrasound of the bladder may show thickening of the bladder wall.
A urologist, a doctor who specializes in bladder health, may also perform a cystoscopy, a test that allows thedoctor to look directly in the bladder through a thin, lighted tube.

•What can I do if I think I have bladder fibrosis? If you are at risk for bladder fibrosis and have any of thesymptoms described above, you should ask for a referral to a urologist.

•When should I call my healthcare provider? Call your healthcare provider if you have symptoms of bladderfibrosis, such as difficulty emptying the bladder, leakage of urine, or blood in the urine.

Bladder cancer•

What is bladder cancer? Bladder cancer is a type of tumor that can develop in people who have been treatedwith cyclophosphamide or radiation involving the bladder. This is a rare type of subsequent cancer due totreatment.

•What are the symptoms of bladder cancer? The most common symptom is blood in the urine. There may also
be a need to urinate urgently or frequently. If the cancer is advanced at the time of diagnosis, there may be pain
over the bladder, in the genital area, or in the bones.

•How is bladder cancer diagnosed? The diagnosis is usually made by doing a cystoscopy to obtain a biopsy ofbladder tissue. Sometimes the diagnosis can be made by finding cancer cells in the urine.

•What can I do if I think I have bladder cancer? If you are concerned about whether your symptoms mayrepresent bladder cancer, ask for a referral to a urologist.

Neurogenic bladder•

What is neurogenic bladder? A neurogenic bladder is abnormal function of the bladder caused by damage tothe nerves that control the bladder’s ability to fill, store and empty urine.

•What are the symptoms of neurogenic bladder? Abnormal bladder function can cause the bladder to beunderactive (not emptying completely) or overactive (emptying too frequently or quickly). People with neurogenic
bladders also have a higher risk of urinary tract infections (UTIs) and kidney damage. (see related Health Link:
Neurogenic bladder after Cancer Treatment)•How is neurogenic bladder diagnosed? Neurogenic bladder can be evaluated by a urologist. To make adiagnosis, your provider may recommend imaging or urodynamic testing.

•What can I do if I think I have neurogenic bladder? If you are concerned about whether your symptoms may
be caused by neurogenic bladder, your provider can refer you to a urologist for additional evaluation and testing.

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Healthy living after treatment of childhood, adolescent, and young adult cancer

Written by Patricia Shearer, MD, MS, Emory Healthcare, Johns Creek, GA; Michael L. Ritchey, MD, Phoenix Childrens Hospital,Phoenix, AZ; Fernando A. Ferrer, MD, Children’s Hospital and Medical Center of Omaha, Omaha, NE; and Sheri L. Spunt, MD, Lucile
Packard Children’s Hospital Stanford University, Palo Alto, CA.
Reviewed by Linda Rivard, RN, BSN; Kayla L. Foster, MD, MPH; and Christine Yun, MSN, PNP, CPON.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or youngadulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s
Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding amedical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
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