Treatment for early (superficial) bladder cancer

Superficial cancers, which can be single or multiple, are usually removed surgically by a cystoscope. Anti-cancer drugs (chemotherapy or immunotherapy) may be put into the bladder to try to prevent the cancer from coming back (recurring).

Removal of superficial bladder tumours

Many tumours in the bladder are the small papillary type. These can usually be removed very easily using a cystoscope. The tumour is snipped off at the stem and the area is cauterised (burned), using a mild electrical current to prevent excessive bleeding. This procedure is known as a transurethral resection of a bladder tumour (TURBT) and in this way, several tumours can be treated at the same time.

After this type of treatment, follow-up cystoscopies are needed at regular intervals (usually every three to four months at first) because the tumours can often come back. Most follow-up cystoscopies are done in the outpatients department under local anaesthetic. If the cancer does come back, the tumours can usually be surgically removed while they are still in the early stages. However, some people at this stage may also have chemotherapy or BCG given directly into the bladder.

Intravesical chemotherapy

Chemotherapy may be used to treat some people with superficial cancer of the bladder. In this case it is given directly into the bladder. Chemotherapy given into the bladder is called intravesical chemotherapy. The most commonly used drugs in this situation are mitomycin-C and epirubicin.

The drugs are given into the bladder through a flexible tube (catheter). Giving chemotherapy in this way puts the drugs into direct contact with the cancer cells in the lining of the bladder. It also causes very few side effects, as very little gets into the bloodstream to affect the rest of the body.

The drugs may be given once, or as a course of weekly treatments for about six weeks.

Side effects of intravesical chemotherapy

Chemotherapy directly into the bladder may cause cystitis (inflammation of the bladder lining). This can lead to soreness or pain and you may need to pass urine more often than normal. Your doctor can prescribe medicines to reduce this effect. Some drugs can also make the skin of the hand or perineum (the area between the openings to the bowel and bladder) sore if they come into contact with them.

Intravesical BCG

A vaccine called BCG (the vaccine used to prevent tuberculosis) can be put into the bladder and is an effective treatment for some superficial bladder cancers. BCG is a type of immunotherapy. Immunotherapy stimulates the body’s immune system to destroy the cancer cells.

The exact way in which this treatment works is not fully known, but it seems that the vaccine can set up a local reaction in the bladder that triggers the body’s immune system to reduce or get rid of the cancers.

The treatment is given in the urology outpatient department. It is given once a week, for six weeks. The vaccine is a liquid that is given directly into the bladder through a tube (catheter). You should not pass urine for two hours afterwards, as the treatment is working during this time. For the next six hours, when you do pass urine, you should sit rather than stand (men as well as women) to avoid splashing.

Side effects of BCG

During the treatment you may have some side effects, such as: blood in your urine; fever and chills; needing to pass urine often; pain in your joints; nausea and vomiting; pain when you pass urine; a cough; a skin rash and feeling very tired.

These effects are common and they almost always settle down on their own. However, you should tell your doctor or nurse about them when you next see them.

It is important to let your doctor know about any other drugs you are taking, because drugs that suppress your immune system may interfere with how well your bladder cancer responds to this treatment.

Repeated treatment with BCG

The treatment may be repeated at times over the next two years. If this is necessary your doctor will arrange it with you.