Treating non-muscle-invasive bladder cancer

Non‑muscle‑invasive bladder cancer (cancer that has not grown into the muscle wall of the bladder) is divided into 3 categories. These categories describe how likely it is that the cancer will spread to the muscle wall or further, or will come back after it's been treated. The 3 categories are called:

  • low‑risk non‑muscle‑invasive bladder cancer

  • intermediate‑risk non‑muscle‑invasive bladder cancer

  • high‑risk non‑muscle‑invasive bladder cancer.

The types of tests and treatments you should be offered for non‑muscle‑invasive bladder cancer depend on which of these 3 categories it's in.

If you have non‑muscle‑invasive bladder cancer, you should be told whether it is low‑risk, intermediate‑risk or high‑risk.

Treating low-risk non-muscle-invasive bladder cancer

If the tissue samples that were removed during your TURBT operation turn out to be low‑risk bladder cancer, you may not need more treatment because the cancer will have been removed. For information about the TURBT operation see taking tissue samples for testing.

You should be offered a cystoscopy to check your bladder 3 months later, and another one 9 months after that. If there is no sign of cancer at either of these check-ups you should be discharged back to your GP. For more information about cystoscopy see looking inside the bladder.

If your cancer comes back, you may be offered a treatment called fulguration, which uses an electric current to destroy the cancer. You may be offered fulguration if you have been free of cancer for at least 6 months and your new cancer is small.

Treating intermediate-risk non-muscle-invasive bladder cancer

You should be offered a course of at least 6 doses of chemotherapy with a drug called mitomycin C. The drug is a liquid that is put into your bladder through a thin tube called a catheter.

You should be offered a cystoscopy to check your bladder 3 months, 9 months and 18 months after you finish your chemotherapy, then once a year after that. For more information about cystoscopy see looking inside the bladder.

If the chemotherapy hasn't helped and your cancer has come back, your care should be referred to a specialist urology multidisciplinary team.

If the cancer hasn't come back after 5 years of check‑ups, you may be discharged back to your GP.

Treating high-risk non-muscle-invasive bladder cancer

If you have high risk non muscle invasive bladder cancer, you should be offered another TURBT operation as soon as possible and no later than 6 weeks after your last TURBT (for more information about the TURBT operation see taking tissue samples for testing ). You may also be offered more CT scans or MRI scans . The TURBT operation and the scans are to double-check how far your cancer has grown before you and your care team talk about possible treatments.

To treat your cancer you should be offered a choice of either:

  • a course of treatment with a vaccine called BCG or

  • an operation to remove your bladder (called a cystectomy).

A urologist who carries out both types of treatment and a clinical nurse specialist should discuss both treatment options with you. They should talk to you about the stage of your cancer and how likely it is to spread. They should tell you how well these treatments have worked for other people and what the risks of each treatment are. They should also explain the effect each treatment might have on your general health and your quality of life, including your sex life, and how you might feel about your body after treatment.

Having treatment with BCG

BCG (short for Bacille Calmette‑Guérin) is a vaccine for tuberculosis and is also used to help stop some kinds of bladder cancer from spreading or coming back again. The BCG is a liquid that is put into your bladder through a thin tube called a catheter. If the BCG treatment doesn't work and your cancer is still there or comes back after treatment, or if the side effects of the BCG are too strong for you to carry on with it, your care should be referred to a specialist urology multidisciplinary team.

After your treatment you should be offered a cystoscopy to check your bladder:

  • every 3 months for the first 2 years, then

  • every 6 months for the next 2 years, then

  • once a year after that.

For more information about cystoscopy see looking inside the bladder.

Having an operation to remove your bladder (cystectomy)

If you decide to have your bladder removed, you will need to have a new way of storing urine and passing it out of your body. There are different procedures for this and you should be offered a choice of procedures that are suitable for you. In one type of procedure a small opening called a 'stoma' is made in your abdomen, and the urine drains out through the stoma into a waterproof bag worn outside your abdomen. There are other types of procedures that don't involve a bag worn outside the body, although they are not suitable for everyone.

A surgeon who specialises in treating bladder cancer, a clinical nurse specialist and a nurse who looks after people who've had these procedures (often called a stoma care nurse) should explain the options and discuss them with you.

Chemotherapy after having your bladder removed

You may be offered chemotherapy with a combination of drugs if the operation to remove your bladder shows that your cancer has spread into the muscle and is now muscle‑invasive bladder cancer. This is called 'adjuvant' chemotherapy. You should have an opportunity to talk about the possible advantages and disadvantages of this chemotherapy with an oncologist who treats people with bladder cancer.

For more information see treating muscle-invasive bladder cancer.

After you've had your bladder removed, you should be offered check-ups that may include:

  • CT scans 6 months after your bladder has been removed and once a year after that, to check whether the cancer has come back or there are any problems with your kidneys

  • blood tests at least once a year to check whether your body is absorbing enough vitamin B and how well your kidneys are working

  • if you're a man, tests to check your urethra once a year for 5 years.

After any type of treatment for non-muscle-invasive bladder cancer

Tell your GP straight away if there is blood in your urine, or you have problems urinating, after any type of treatment for non‑muscle‑invasive bladder cancer. They should refer you to a specialist without delay.

Questions to ask your care team

About non-muscle-invasive bladder cancer

  • Can you tell me more about the difference between low‑risk, intermediate‑risk and high‑risk non‑muscle‑invasive bladder cancer?

  • How will I know if the cancer has come back after my treatment? What should I look out for?

  • Is there anything I can do to reduce the chance of the cancer coming back?

  • What will happen if the cancer does come back?

  • Who should I call if I have problems urinating or there's blood in my urine?

About high-risk non-muscle-invasive bladder cancer

  • Will I have a specialist urology multidisciplinary team? Who is on the team and what do they do?

  • Can you tell me about the advantages and disadvantages of BCG treatment compared with removal of the bladder (cystectomy)?

  • Is there some other information that I can have about BCG treatment and cystectomy (like a leaflet, DVD or a website I can go to)?

  • Can I talk to someone who has had BCG treatment and someone who has had cystectomy?

  • Are there any other options for treatment?

  • If I have BCG treatment now, will I still be able to have a cystectomy later?

  • What options would I have for storing and draining urine if I have my bladder removed? Can I talk to people who have had these options?

  • What support can I have after my treatment?

  • Will I need to have check-ups every year from now on?

  • What will happen if the cancer spreads?

  • Information Standard