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