Non-invasive bladder cancer

Non-Invasive Bladder Cancer is a bladder cancer that hasn’t spread into the muscle of your bladder and is kept inside the lining of the bladder. The vast majority of bladder cancers, over 70%, are found at this stage. This is also sometimes called ‘superficial bladder cancer’ or ‘early stage bladder cancer’.

Bladder cancer is, however, the cancer that has the highest recurrence rate. This will mean that you are likely to have a lifetime relationship with investigations and treatments as your medical team works to remove the tumours and then works hard again to help prevent them coming back. You will have regular check ups with a cystoscopy to see if the bladder cancer has come back and your treatment will begin again if it does.

Treatments you may be offered

In cases of non-invasive bladder cancer, it is usually possible to remove the cancer cells while leaving the rest of the bladder intact. This is done using a surgical technique called transurethral resection (TURBT). This is sometimes followed by a course of chemotherapy, which is placed directly into the bladder to prevent the cancer returning. This method of using chemotherapy directly into the bladder reduces the risk of some side-effects, such as hair loss.

If your bladder cancer is the lower risk type it is possible that you will not need any more treatment than the TURBT and the initial chemotherapy installation. You will be monitored for a year to make sure it doesn’t come back and the current guidelines suggest that you can be discharged at this point but do watch out for any symptoms.

Your treatment will also usually include a medication known as BCG (Bacillus Calmette-Guerin) which is injected into your bladder. BCG has been found to encourage the immune system to destroy any remaining cancerous cells. The immune system is the body’s natural defence against infection and illness. The BCG treatment is commonly carried out over a number of weeks in outpatient appointments. If you are about to start treatment with BCG we would recommend that you join our Confidential Forum to speak to others who have had this treatment. They can share their experiences of the treatment and their tips for dealing with the realities of the treatment course.

Your medical team will aim to remove all the cancer cells by the TURBT procedure (explained in more detail below), but they will further refine their treatment recommendations as the procedure progresses, and once they have the additional results from any biopsy. They will recommend treatment based on limiting the risk of the cancer coming back or spreading further than the lining of your bladder.

The risk is calculated using a series of factors, including:

• the number of tumours that are present in your bladder
• whether the tumours are larger than 3cm (1 inch) in diameter
• whether you have had bladder cancer before
• whether the tumours are limited to your bladder lining, or whether they’ve started spreading beyond the lining (the STAGE)
• the GRADE of the cancer cells which describes how aggressively they are likely to grow and spread, with low grade being the least aggressive and high grade being the most aggressive

Quite simply, the exact treatment you will be offered depends on your medical team’s view on the risk of your cancer returning.

• If the risk of your cancer returning or spreading is low, your recommended treatment plan will usually be surgery to remove the tumours, followed by a course of chemotherapy that is placed inside your bladder
• If the risk of your cancer returning or spreading is moderate, you will be given a longer course of chemotherapy after you’ve had surgery
• If the risk of your cancer returning or spreading is relatively high, as well as surgery and chemotherapy, you will be probably be given a course of the BCG vaccine

Sometimes, with a non=invasive bladder cancer that is very high risk, you might be asked to consider having your bladder removed as the best way of dealing with your diagnosis. This might sound very frightening but it is a common treatment for those of us who have been diagnosed with invasive bladder cancer. If this is suggested to you please do have a look at our section on invasive bladder cancer that covers this surgery and our Patient Choices download. 

BCG (Bacillus Calmette-Guerin) vaccine

The BCG vaccine is used to treat the higher-risk cases of non-invasive bladder cancer to reduce the risk of the cancer returning.

The BCG vaccine was originally used to treat tuberculosis (TB), but it has also proved to be an good treatment for bladder cancer. Exactly how it works is still unclear. It appears to stimulate the immune system to target and destroy any remaining cancer cells. The vaccine is given in the same way as intravesical chemotherapy – a liquidised version is passed directly into your bladder. The vaccine will be left in your bladder for 2 hours before being drained away.

Following treatment with BCG, you will also need to be careful about not splashing yourself or the toilet seat with wee.

The current advice is for an induction treatment in the first year after diagnosis and then either 1 or 2 more years of maintenance treatments whilst having regular check-ups.

The induction course is normally weekly treatments over a 6-week period. Maintenance therapy of up to another 2 years of treatment may be recommended after the induction course, which will involve further doses of the BCG vaccine every 6 months, with a series of 3-weekly doses.

The common side effects of BCG treatment include:

• a frequent need to wee
• pain when weeing
• blood in your wee

You should inform your medical team if the side effects become particularly troublesome because other treatments are available to help.

BCG treatment can sometimes be uncomfortable or painful. Some people are lucky and sail through the treatment, whilst others have quite a difficult time during the process.

Tips to help with your BCG treatment

Before treatment:

• It’s a good idea not to eat or drink for a period of time before the treatment.
• Be prepared to provide a urine sample before the treatment. If this sample shows signs of infection, you will not be treated with BCG until it clears up.
• Your consultant will not give you BCG until your bladder has healed from removing the tumors during a TURBT. (This reduces the risk of the BCG getting into your blood stream through a cut.)
• Bring a friend or family member along if you feel it would make you feel more comfortable.

During treatment:

• The procedure is usually quick and relatively painless. The liquid drug is fed into your bladder via a catheter.
• Although it is quite difficult for some people, you must try and hold the liquid for as long as possible, ideally 2 hours, to allow the treatment to work as well as it can.

After treatment:

• The treatment can cause side effects, such as tiredness, flu-like symptoms, the urge to wee a lot, pain when weeing or symptoms of a UTI. You may have blood or blood clots in your wee. Contact your doctor if your side effects worry you – don’t suffer in silence. For great advice, join our Confidential Forum and talk to people who are going through the same procedure.
• Ask your consultant about pain relief. Pain with BCG treatment is quite common, but most people get all the relief they need with simple painkillers. If these don’t work though, talk to your consultant or specialist nurse and they can help you choose other painkillers that might work better for you.
• Side effects are different in different people. They are generally short lived, but may get worse after additional treatments. If your side effects become difficult to deal with, you may be able to get lower doses of BCG at your next treatment. Again, talk to your consultant and don’t suffer in silence. 

Living with bladder cancer

Bladder cancer has the highest recurrence rate of any cancer, so it is possible that you will have a lifetime relationship with this cancer. You will soon settle down into the routine of checks and possible additional treatments. Sometimes it is good to talk to others in the same situation, so do visit our Confidential Forum.

Sometimes, despite the best medical intervention, non-invasive bladder cancer can still progress to invasive bladder cancer. If this is happening to you, find out more about the treatments and options you now face on our page about invasive bladder cancer.

Remember that the majority of people diagnosed with bladder cancer do beat it. You can find out more about life after bladder cancer in our surviving bladder cancer section.