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 called 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 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 non muscle invasive bladder cancer are:

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


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 you have low risk, intermediate (moderate) risk or high 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.

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 might have BCG instead of chemotherapy if you are unable to continue with chemotherapy due to side effects.

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 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 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 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.

  • European Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS)
    M Babjuk and others
    European Association of Urology, 2022

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

  • BMJ Best Practice. Bladder Cancer
    D Lamm
    BMJ Publishing Group, (Updated July 2022)

  • Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.
    T Powles and others
    Annals of oncology, 2022 Volume 33, Issue 3, Page 244 - 258

  • 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. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
07 Mar 2023
Next review due: 
07 Mar 2026

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