Superficial bladder cancer treatment

If cancer cells are found only in the inner layers of the bladder, the cancer is called superficial or non-muscle-invasive bladder cancer (NMIBC). The main treatment for superficial bladder cancer is surgery to remove the cancer. This is often done during diagnosis. Surgery is commonly combined with chemotherapy or immunotherapy, which is delivered directly into the bladder (intravesical).

Surgery (TURBT)

Most people with superficial bladder cancer have an operation called transurethral resection of bladder tumour or TURBT. This procedure is usually done during diagnosis.

If the cancer has spread to the lamina propria or is high grade, you may need a second TURBT 2–6 weeks after the first procedure to make sure that all cancer cells are removed. If the cancer comes back after initial treatment, your surgeon may do another TURBT or suggest removing the bladder in an operation called a cystectomy.

Check-ups after surgery

Cancer can come back even after a TURBT has removed it from the bladder. You will need regular follow-up cystoscopies to find any new tumours in the bladder as early as possible. This approach is known as surveillance cystoscopy.

How often you need to have a cystoscopy will depend on the stage and grade of the cancer, and how long since it was diagnosed.

Intravesical chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells.

Chemotherapy drugs are usually injected into a vein or given as tablets. In intravesical chemotherapy, the drugs are put directly into the bladder using a catheter (a thin, flexible tube) inserted through the urethra.

Intravesical chemotherapy is used mainly for low-risk to medium-risk superficial bladder cancer. It helps prevent the cancer coming back (called a recurrence).

Each dose is called an instillation, and this is usually given in a day procedure in hospital.

People with a low risk of recurrence usually have one instillation straight after TURBT surgery. The chemotherapy solution is left in the bladder for 1–2 hours and then drained out through a catheter or by urinating after the catheter has been removed. You may be asked to change position every 15 minutes so the solution washes over the whole bladder.

People with a medium risk of recurrence may have instillations once a week for about 6 weeks. While you are having a course of intravesical chemotherapy, your doctor may advise you to use contraception.

Side effects of intravesical chemotherapy

Because intravesical chemotherapy puts the drugs directly into the bladder, it has fewer side effects than systemic chemotherapy (when the drugs spread through the whole body).

The main side effect of intravesical chemotherapy is inflammation of the bladder lining (called cystitis). Signs of cystitis include wanting to pass urine more often or having a burning feeling when urinating. Drinking plenty of fluids can help. If you develop a bladder infection, your doctor can prescribe antibiotics.

In some people, intravesical chemotherapy may cause a rash on the hands or feet. Tell your doctor if you notice any side effects while on intravesical chemotherapy.

Intravesical immunotherapy (BCG)

Immunotherapy is treatment that uses the body’s own natural defences (the immune system) to fight disease. Bacillus Calmette-Guérin (BCG) is a vaccine that was originally used to prevent tuberculosis. It can also stimulate a person’s immune system to stop or delay bladder cancer coming back or becoming invasive.

The most effective way to treat high-risk superficial bladder cancer is with a combination of BCG and TURBT (see Diagnosis and Treatment. Some time after TURBT surgery, BCG will be given once a week for about 6 weeks. BCG is put directly into the bladder through a catheter.

You may be asked to change position every 15 minutes so the vaccine washes over the whole bladder. This is usually done as a day procedure in hospital, and each treatment session takes up to 2 hours.

The BCG vaccine contains live bacteria, which can harm healthy people, so your treatment team will tell you what safety measures (see below) to follow at home. Speak to your medical team if you have any questions.

Ongoing BCG treatment

For most people with high-risk superficial bladder cancer, the initial, 6-week course of BCG treatments is followed by more BCG. This is called maintenance BCG and it reduces the risk of the disease coming back or spreading.

Maintenance treatment can last for 1–3 years, but treatment sessions become much less frequent (e.g. one dose a month). Treatment schedules can vary so ask your doctor for further details and see above for safety measures to take at home.

Side effects of BCG

Common side effects of BCG include needing to urinate more often; burning or pain when urinating; blood in the urine; a mild fever; and tiredness. These side effects usually last a couple of days after each BCG treatment session.

Less often, the BCG may spread through the body and can affect any organ. If you develop flu-like symptoms, such as fever over 38°C that lasts longer than 72 hours, pain in your joints, a cough, a skin rash, tiredness, or yellow skin (jaundice), contact a nurse or doctor at your treatment centre immediately. A BCG infection can be treated with medicines.

Very rarely, BCG can cause infections in the lungs or other organs months or years after treatment. If you are diagnosed with an infection in the future, it is important to tell the doctor that you had BCG treatment.