Treatment options for non muscle invasive bladder cancer

Non muscle invasive bladder cancer means the cancer cells are only in the bladder’s inner lining. It’s also called superficial bladder cancer.

This page is about treatment options for non muscle invasive bladder cancer.

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

A team of health professionals decides what treatment you need. The most common treatments for non muscle invasive bladder cancer are:

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

Deciding which treatment you need

Your doctor will talk to you about your treatment, its benefits, and the possible side effects.

A team of doctors and other professionals might discuss your treatment plan. They are a multidisciplinary team (MDT). The MDT should discuss your care if your bladder cancer comes back (relapses). Or if you have high risk non muscle invasive bladder cancer.

The MDT includes:

a urologist - a surgeon specialised in treating bladder problems
an oncologist – a cancer specialist
a radiologist – a doctor specialising in reporting x-rays and scans
a specialist urology nurse – also called a clinical nurse specialist (CNS)
a pathologist - a doctor who specialises in looking at cells under the microscope

The treatment you have depends on:

the size of your tumour (T stage)
what the cells look like under a microscope (grade)
whether you have any carcinoma in situ (CIS)
how many tumours there are
how wide the tumour is (diameter)
whether this is your first diagnosis, or it has come back (a recurrence)

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 your early bladder cancer is:

low risk
intermediate risk
high risk

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 non muscle invasive bladder cancer are:

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

Surgery

Everyone 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 bladder cancer need to have surgery to remove their bladder. This operation is called a cystectomy.

Treatment into your bladder

You might have chemotherapy into the bladder (intravesical chemotherapy) after your surgery. This lowers the risk of the cancer coming back.

Or, you might have a vaccine called BCG into your bladder.

Treatment by risk group

Your doctor should tell you whether your non muscle invasive bladder cancer is:

low risk
intermediate (moderate) risk
high risk

Treatment for low risk non muscle invasive 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.

Some people with low risk bladder cancer have regular check ups to look for any changes to their bladder. At these check ups they have a cystoscopy . This uses a tiny camera to look inside the bladder and urethra.

Treatment for intermediate (moderate) risk non muscle invasive bladder cancer

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

Usually you then have courses of chemotherapy into your bladder for up to a year. Or you might have BCG cycles for up to a year instead of chemotherapy. This is likely to happen if you are unable to continue with chemotherapy due to side effects.

Treatment for high risk non muscle invasive bladder cancer

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 and if the first TURBT was incomplete.

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 for 1 to 3 years
surgery to remove the bladder (radical cystectomy)

You need to talk to your specialist doctor and nurse about these treatments. They can go through the risks and benefits with you. 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 treatment, 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 a cystoscopy again. This happens 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 might suggest you have more intensive treatment such as surgery to remove your bladder (cystectomy). They might recommend this 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.