Treatment for non-invasive bladder cancer

Saturday 1 March, 2014

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On this page: Surgery | Intravesical chemotherapyImmunotherapyKey points


The main types of treatment for non-invasive bladder cancer are surgery, intravesical chemotherapy or immunotherapy. Surgery, alone or combined with other treatments, is used in most cases.

After treatment, your doctor will follow up with you regularly.

Surgery

If you have a cystoscopy to diagnose the cancer, the doctor may be able to remove the tumour during the procedure. Most people with non-invasive bladder cancer have a type of surgery called transurethral resection of bladder tumour (TURBT).

The TURBT is done under a general anaesthetic. The operation takes 15–40 minutes, and does not involve any external cuts to the body. A rigid slender tube with a light and lens, called a cystoscope, is passed through the urethra and into the bladder. The cystoscope has a wire loop that allows the doctor to remove the tumour through the urethra.

During the operation, the surgeon may use other techniques to kill the cancer cells. These could include burning the base of the tumour (fulguration) with the cystoscope or using a high-energy laser to damage or kill the cancer cells.

If the cancer comes back, you may have another TURBT or the bladder may be removed (cystectomy). This is also the option if you have a high-grade cancer.

Side effects
  • Length of hospital stay
    Most people who have TURBT surgery are in hospital for 1–3 days.
  • Drips and tubes
    You may have a thin tube (catheter) in your bladder, which drains your urine into a bag. The catheter may be connected to a system that washes the blood and blood clots out of your bladder. This is called bladder irrigation. When there is no longer a risk of clots, the catheter will be removed and you will be able to go home. If the tumour is small, there may be no need for a catheter, and you may be discharged from hospital on the same day.
  • Recovery
    It is important to give your body time to heal after the surgery, and your doctor will advise you about gradually returning to your usual activities. Try to avoid any heavy lifting or strenuous exercise in the early weeks of recovery.
  • Blood in urine
    It is normal to see blood in your urine for up to two weeks after the procedure.
  • Urine infection
    You may be prescribed antibiotics to prevent bladder infection. Signs to look for include pain or burning when urinating, passing blood clots or difficulty passing urine.

Some people are given intravesical chemotherapy immediately after or within 24 hours of surgery.

Intravesical chemotherapy

Chemotherapy treats cancer by damaging cancer cells as they are growing and dividing. Unlike normal cells, cancer cells are unable to repair this damage and die.

Chemotherapy drugs are usually given by mouth or injected into a vein. However, in intravesical chemotherapy, the drugs are put directly into the bladder using a flexible tube called a catheter.

Intravesical chemotherapy is only used for non-invasive bladder cancer, as the chemotherapy delivered to the bladder is not able to reach cancer cells in any surrounding tissues or cells that have spread to other parts of the body. Each treatment is called an instillation. The chemotherapy treatment may be given as one instillation at the time of surgery, or as weekly instillations for six weeks. During this time, your doctor may advise you to use contraception.

Side effects

Giving chemotherapy directly into the bladder does not cause as many side effects as when the drugs are given intravenously and reach the whole body.

The main side effect is bladder irritation (cystitis). Signs include wanting to pass urine more often or burning feeling when urinating. Drinking plenty of fluids after treatment can help. If you think you have an infection, let your health care team know so that you can be prescribed antibiotics. In some people, intravesical chemotherapy may cause a rash on the hands or feet.

Immunotherapy

Immunotherapy uses substances that encourage the body’s own natural defences (immune system) to fight disease. Bacillus Calmette-Guérin (BCG) is a vaccine originally developed to prevent tuberculosis, but it can also stimulate the immune system to stop or delay bladder cancer coming back or becoming invasive.

BCG, in combination with TURBT, is the most effective treatment for non-invasive bladder cancers or carcinoma in-situ. It can also be used to treat invasive cancer that has grown into the lamina propria.

BCG is usually given once a week for six weeks, starting 2–4 weeks after TURBT surgery. It is put directly into the bladder through a catheter. You may be asked to change position every 15–20 minutes so the vaccine washes over the entire bladder.

Some people may have long-term BCG therapy, which involves three treatments over a six-month period, for up to two years. This is called maintenance treatment. Maintenance treatment has been shown to reduce the risk of non-invasive disease progressing and invading deeper into the bladder wall (muscle).

Let your doctor know of any other drugs and complementary therapies you are taking, as they may interfere with how well the bladder cancer responds to BCG. For example, the drug warfarin (a blood thinner) interacts with BCG.

Side effects

Common side effects include blood in your urine, needing to urinate more often and burning or pain when you pass urine. For people on maintenance therapy, these side effects may worsen with each treatment. If you develop flu-like symptoms, such as fever, pain in your joints, a cough, a skin rash or severe tiredness, it is important to contact your nurse or doctor immediately. This may mean a BCG infection has spread throughout the body. This is uncommon.

BCG and safety at home

After BCG treatment your medical team will ask you to follow these safety measures. This is because BCG is a vaccine that contains live bacteria, which can harm healthy people.

  • Sit down on the toilet when urinating to avoid urine splashing.
  • Use household bleach to disinfect the toilet for the first few few hours after treatment. Pour a small amount of bleach into the toilet bowl and leave it to stand for 15 minutes before flushing and wiping the toilet seat.
  • Wash your hands thoroughly.
  • If you are advised to wear an incontinence pad in case of leakage, place it in a sealed plastic bag after removal or take it back to the hospital or treatment centre for disposal in a biohazard bin.
  • Wash any clothing splashed with urine in a separate load with bleach and warm water.
  • Speak to your doctor or nurse if you’re concerned about these precautions.

Key points

  • The main treatments for non-invasive bladder cancer include surgery, intravesical chemotherapy and BCG (immunotherapy). These treatments may be used alone or in combination.
  • The doctor may be able to remove the cancer during a cystoscopy. However, most people have a transurethral resection of bladder tumour (TURBT) operation.
  • In a TURBT, a tube is passed through the urethra and into the bladder, and the doctor uses a wire loop or laser to remove the cancer.
  • TURBT can be repeated if the cancer comes back.
  • Blood in the urine, pain and discomfort are common side effects after bladder surgery.
  • Chemotherapy drugs are put directly into the bladder through a flexible tube called a catheter. This is called intravesical chemotherapy.
  • Each time the chemotherapy drugs are inserted, it is called an instillation.
  • The most common side effect of intravesical chemotherapy is bladder irritation (cystitis).
  • Immunotherapy uses a vaccine called Bacillus Calmette-Guérin (BCG), which is inserted directly into the bladder. BCG causes the body’s immune system to try to destroy the cancer. It may be given weekly for six weeks or possibly more.
  • BCG may cause flu-like side effects, and because it is a live vaccine you may need to take some extra safety precautions

Reviewed by: Dr Mohan Arianayagam, FRACS (Urol), Urologic Oncologist, Nepean Hospital, Penrith, NSW; Donna Clifford, Urology Nurse Practitioner Candidate, Royal Adelaide Hospital, SA and David Connah, Cancer Council Connect Consumer Volunteer.
Updated: 01 Mar, 2014