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Treatment decisions

Early bladder cancer means the cancer cells are only in the bladder’s inner lining. It’s also called superficial bladder cancer, or non muscle invasive bladder cancer.

This page is about how your doctor decides which treatment you need for early bladder cancer.

We have a separate section about treating invasive bladder cancer which has spread into or through the muscle layer of the bladder. 

Deciding which treatment you need

Your doctor will talk to you about your treatment, its benefits, and the possible side effects. If your bladder cancer returns (recurrence) or you have high risk non muscle invasive bladder cancer, your treatment plan is first discussed with a team of doctors and other professionals. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • the size of your tumour (T stage)
  • what the cells look like under a microscope (grade)
  • how many tumours there are
  • the type of bladder tumour you have
  • whether you have had treatment in the last year for early bladder cancer

After surgery, the doctor sends samples (biopsies) of the cancer to the laboratory. They check the type and grade of the cancer cells to see if you have low risk, intermediate risk or high risk early bladder cancer. These risk groups describe how likely it is that your cancer will spread or come back after treatment. Your risk group helps the doctor decide what further treatment you may need.

Treatment overview

The main treatments for early bladder cancer are:

  • surgery
  • chemotherapy into your bladder
  • a vaccine called BCG into your bladder

Surgery

Everyone with early bladder cancer has surgery to remove the cancer from their bladder lining. This operation is called trans urethral resection of bladder tumour (TURBT). You may have this surgery during or after tests to diagnose your cancer.

Some people with high risk early bladder cancer go on to have surgery to remove their bladder (a cystectomy).

Treatment into your bladder

Usually, you also have chemotherapy into the bladder (intravesical chemotherapy) after your surgery. This lowers the risk of the cancer coming back.

You might have a vaccine called BCG into your bladder if you have a high risk of cancer coming back or spreading into the deeper layers of your bladder.

Treatment by risk group

Your doctor should tell you whether you have low risk, intermediate (moderate) risk or high risk early bladder cancer.

You have surgery (TURBT) to remove the cancer from your bladder lining. You might also have chemotherapy into your bladder (intravesical chemotherapy).

You may not need any further treatment if your doctor completely removes your cancer during surgery.

You have surgery (TURBT) to remove the cancer from your bladder lining. 

Usually you then have a 6 week course of chemotherapy into your bladder.

You have surgery (TURBT) to remove the cancer from your bladder lining. 

You have a second TURBT operation within 6 weeks of the first. This is to double check how far your cancer has grown.

Your bladder cancer specialist (urologist) will tell you about 2 further treatment choices. You may have:

  • a course of treatment with the BCG vaccine into the bladder
  • surgery to remove the bladder (radical cystectomy)

You need to talk to your specialist doctor and nurse about the risks and benefits of these treatments. They will tell you about the stage of your cancer and how likely it is to spread. They will also tell you how well these treatments have worked for other people, and about the possible side effects.

Follow up

After any treatment for early bladder cancer, your specialist keeps a close eye in case the cancer comes back.

You have regular cystoscopies for some years. How often you have these depends on your bladder cancer risk group.

If your bladder cancer comes back

The surgeon can remove the growths with cystoscopy again if stage Ta or T1 bladder cancer comes back after treatment.

Your specialist takes more biopsies to check that the cancer is still at an early stage. If it is, you usually have chemotherapy or BCG treatment into the bladder. You then go back to having regular cystoscopies to check your bladder.

Your doctor may ask you to have more intensive treatment if your cancer is:

  • grade 3 (the cancer cells look very abnormal)
  • at a more advanced stage than before
  • carcinoma in situ (CIS) that has come back after treatment into the bladder

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Last reviewed: 
07 Jun 2019
  • European Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS)
    M Babjuk and others
    European Association of Urology, 2017

  • Bladder cancer: diagnosis and management
    National Institute of Health and Care Excellence, 2015

  • BMJ Best Practice. Bladder Cancer
    D Lamm
    BMJ Publishing Group, (Updated June 2018)

  • Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up
    J Bellmunt and others
    Annals of Oncology, 2014. Volume 25, Supplement 3, Pages 40-48

  • Bladder cancer: overview and disease management. Part 1: non-muscle-invasive bladder cancer
    B Anderson
    British Journal of Nursing, 2018. Volume 27, Number 9, Pages 27 – 37

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular risk or cause you are interested in. 

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