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Bladder cancer treatment is versatile and all treatments are depending on the stage. Generally you
may have Surgery, chemotherapy, Radiotherapy. You may have BCG vaccine at the primary stage
of your cancer.
Surgery:
Early bladder cancer is also called superficial bladder cancer or non muscle invasive bladder
cancer. This means that the cancer cells are only in the inner lining of the bladder. There
are 3 stages of early bladder cancer
• Stage Tis (also called CIS or carcinoma in situ)
• Stage Ta
• Stage T
If you have early bladder cancer, your specialist will remove the tumours from the bladder
lining during a cystoscopy under general anaesthetic. This procedure is called a TURBT
(trans urethral resection of bladder tumours). This means that the tumours are removed using
a thin tube called a cystoscope. Your surgeon puts the cystoscope into the bladder through
your urethra (the tube that connects your bladder to the outside). This is sometimes done
during tests to diagnose bladder cancer.
After removing the tumours from the bladder lining your doctor sends them to the laboratory
for examination. Any biopsies that the surgeon takes from the rest of your bladder lining
will also be sent to the lab to be examined. The pathologist who examines the biopsy samples
will tell your doctor which grade of bladder cancer you have.
Invasive bladder cancer means that the cancer cells have spread beyond the inner lining and
into the muscle layer of the bladder. There is a risk that the cancer could spread to other
areas of the body if it is not treated.
If your cancer has spread into the muscle layer of your bladder you will need to have
surgery immediately. Surgery for invasive bladder cancer means having quite a big operation.
The techniques for surgery for bladder cancer have been improving over many years.
If you need to have your whole bladder removed, you may be able to have an operation to
create a new bladder. With some operations you have to have a waterproof bag (urostomy bag)
on your tummy (abdomen) to collect the urine afterwards. To prvent the cancer comes back in
the bladder area some time later you will then need to have further treatment with either
chemotherapy into a vein or radiotherapy to the bladder area.
Advanced bladder cancer means the cancer has spread from where it started in the bladder to
another part of the body. Your cancer may be advanced when it is first diagnosed. Or it may
have come back some time after you were first treated. This is called recurrent cancer.
The cancer can spread into structures close to the bladder, such as the ureters or urethra,
prostate or vagina or into the pelvis. This is called local spread. Cancer that has spread
to another part of the body is called a secondary cancer or metastasis.
Not all bladder cancers will spread. If bladder cancer does spread, it is most likely to
spread to the
• Lymph nodes in the pelvis, tummy (abdomen) or neck
• Lungs
• Liver
• Bones
The symptoms of advanced bladder cancer depend on which part of the body the cancer has spread
to. A common symptom is weight loss. Other symptoms can include
• Swollen legs
• Pain in your bones
• Pain in your tummy (abdomen)
• Lumps in your abdomen or neck
• Yellowing of the skin or whites of the eyes (jaundice)
Some people feel increasingly tired when their cancer has spread. But do bear in mind there
are lots of reasons for feeling tired.
For bladder cancer that has spread, you may have surgery. The treatment you have depends on
• How much your cancer has spread
• Where the cancer has spread to in the body
• The treatment you have already had
• Your age and general fitness
If your cancer has grown through the bladder wall or has spread to lymph nodes but no further,
removal of the bladder or radiotherapy to the bladder may cure it. As well as treatment to
your bladder you may have nearby lymph nodes removed or have radiotherapy treatment to them.
These treatments would be followed by chemotherapy into a vein.
If your cancer has spread to another body organ, then unfortunately, treatment is not likely
to cure it. But it may shrink the cancer to control it and reduce symptoms for some time.
Chemotherapy into a vein goes into the bloodstream and travels throughout the body. Chemotherapy
can shrink a tumour and control symptoms.
You may have surgery if the cancer is in the bladder or is blocking urine from passing through
your ureters or urethra.
Cystoscopy to treat cancer in the bladder
If you still have cancer inside your bladder, or if it has grown back, it can make it painful
or difficult to pass urine. The pressure of the cancer growing inside the bladder can be
uncomfortable. The cancer may also sometimes bleed. Your specialist may suggest removing most
of the cancer to stop the bleeding and slow down the cancer. This is called debulking. The
surgery is called transurethral resection (TUR) and is done using a cystoscope.
The TUR is a similar procedure to a cystoscopy. It is done under a general anaesthetic. When
you wake up you will have a tube into your bladder (catheter) connected to a flushing system.
This flushes out any clots that may form in the bladder after your surgery. You will have some
bleeding after this type of surgery for a couple of days. Once it has stopped, the flushing
system (irrigation) will be taken down and your catheter will be taken out.
Relieving a blockage
Sometimes the cancer can block your ureters or kidney. This can make urine build up in the
kidney and stop it from working properly. But relieving the blockage can help the kidney to
work normally again. As well as relieving symptoms, improving your kidney function may mean
that you are able to have chemotherapy.
Your doctor may suggest an operation to bypass the blockage caused by the cancer. In one type
of operation, the doctor puts a small tube (a stent) inside the ureter to allow the urine to
drain. The doctor can sometimes do this with a cystoscope so you won't have a wound afterwards.
More commonly, your doctor may put a tube (called a nephrostomy tube) through the skin and
into the blocked kidney to drain the urine into a bag outside the body. Then, later on, it
may be possible to pass a stent from the kidney into the bladder.
Your doctor will do these procedures to try to relieve your symptoms. So it is important that
the benefit will be greater than the drawbacks of having an operation.
Chemotherapy
After the surgeon has removed the areas of bladder cancer they put chemotherapy into the bladder
through a tube (catheter). This is called intravesical chemotherapy and reduces the risk of the
cancer coming back. You may have
• Mitomycin C
• Epirubicin
• Doxorubicin chemotherapy.
Depending on the grade of your cancer, you may not need any further treatment. Or you may need
to have further treatment into the bladder with chemotherapy or BCG therapy.
Treatment into the bladder is called intravesical therapy for bladder cancer means putting
liquid drugs directly into the bladder through a tube called a catheter. The aim of this
treatment is to treat the cancer and stop it from coming back or spreading into the deeper
layers of the bladder.
After surgery to remove early bladder cancer you have a catheter (tube) put into your bladder.
Your doctor nurse puts a chemotherapy drug into the tube.
The catheter may then be taken out. You have to try not to pass any urine for the next 2
hours. This gives the treatment time to be in contact with the lining of the bladder.
You then pass urine naturally to get rid of the chemotherapy drug. Or your nurse
drains the chemotherapy out through a catheter. For some people with early bladder cancer,
this is all the treatment they need.
People who have grade 2 tumours usually have further treatment with chemotherapy into the
bladder (intravesical chemotherapy). This is to further reduce the chance of the cancer
coming back or spreading. You have a solution of a chemotherapy drug (mitomycin, epirubicin
or doxorubicin) put into your bladder weekly for 6 weeks. You may also have this treatment
if your cancer comes back after the initial surgery and chemotherapy treatment.
People who have CIS or grade 3 tumours usually have treatment with BCG into the bladder
(intravesical BCG). In some cases, your doctor may suggest you have BCG for grade 2
early bladder cancer.
At invasive bladder cancer stage, if you have surgery and there is a high risk of the
cancer coming back afterwards, your doctor may recommend that you have chemotherapy to
reduce the risk of recurrence.
There has been quite a bit of success using chemotherapy to treat advanced bladder cancer.
It can help to control or get rid of advanced bladder cancer for some time. But some
types of bladder cancer chemotherapy can be quite intensive. They take a few months and
can have a lot of side effects. It is the same types of chemotherapy used for invasive
bladder cancer.
In particular, older people who are less fit may find the side effects of intensive
chemotherapy too severe. You may have less intensive types of chemotherapy if you are
very unwell because of the cancer, or if you have
• Other medical problems, such as heart, lung or liver problems
• Poor kidney function
• Widespread secondary (metastatic) cancer
• Or cancer severely affecting your liver or lungs
The less intensive types of chemotherapy can still work very well at shrinking the cancer
and slowing its growth. You would need to discuss with your own doctor which type of
chemotherapy is most suitable for you.
If you had chemotherapy when you were first treated, your doctor will assess how well
the chemotherapy worked for you then. Then they can decide whether it is likely to work
well now. If the chemotherapy did not work well the first time, it is less likely to be
helpful now.
Radiotherapy
Radiotherapy at primary stage is not very scientific, although giving chemotherapy before
surgery or radiotherapy, or combining it with radiotherapy, can help these treatments to
work better.
The main benefit of radiotherapy is that you don't need to have your bladder removed.
The bladder usually shrinks though, so you may find that you need to pass urine more often.
Radiotherapy means going into the hospital each weekday for 6 to 7 weeks to have the
treatment, which can be very tiring. Radiotherapy can also cause short term inflammation
of the bowel, which can cause diarrhoea and may be long term for some people. You may also
have inflammation of the bladder during the treatment, which may make it uncomfortable
to pass urine.
Giving chemotherapy and radiotherapy at the same time has been shown to work better than
radiotherapy on its own for some people. This is called concurrent chemoradiation. For
some people it may cause more severe side effects during treatment than radiotherapy on
its own.
Your specialist may suggest radiotherapy if you have advanced bladder cancer that is
causing you symptoms. For example, if you have pain from cancer that has spread to a bone.
Radiotherapy can work very well in this situation. Sometimes the treatment is given in one
session. But some people have a few treatment sessions. The radiotherapy will not cure your
cancer but it can improve the quality of your life. It can help to keep the cancer under
control in the area of the body that has been treated.
Side effects from radiotherapy depend on which part of the body is treated so it is difficult
to give general information about the side effects. When radiotherapy is being given to treat
symptoms, doctors try to keep the side effects down to a minimum. If you are having just one
treatment, or a short course, you may not have very many side effects at all.
If you had radiotherapy to your bladder and pelvis when you were first treated, then you will
probably not be able to have any more to that area. This is because there is a limit to the
amount of radiation any part of the body can have. But you can have radiotherapy to another
part of the body if necessary.
BCG
BCG is a vaccine for tuberculosis (TB). It is also very good at helping to stop bladder cancers
growing back in the bladder or spreading into the deeper layers of the bladder. You usually have
BCG treatment weekly for 6 weeks. You may also have another BCG intravesical therapy 6 weeks after
your last weekly treatment, and then every few weeks or months for the next 3 years. This is
called maintenance BCG therapy.
The BCG is a liquid and your doctor or nurse put it into your bladder through a tube (catheter).
They usually then remove the catheter. You should not pass urine for 2 hours. When you do pass urine,
you have to be careful for 6 hours after the treatment because the vaccine contains live TB. Men
should sit down to pass urine, to reduce the chance of splashing. You should try not to get any
urine on your hands. After you've been to the loo, pour about half a pint of neat bleach into the
toilet bowl and leave it for 15 minutes before flushing. This makes sure you are not flushing live
TB into the sewer system. Then, as always, wash your hands as the treatment may irritate your skin.
Doctors are not quite sure how BCG works for bladder cancer. It seems to encourage cells of the
immune system to grow and become very active in the lining of the bladder. BCG seems to work as
a type of immunotherapy. These cells of the immune system probably kill off any cancer cells
that might grow back or have been left behind in the bladder lining.
You probably won't have too many side effects from this treatment, although it can cause more
side effects than chemotherapy into the bladder.
• About 2 out of 3 people have an irritated bladder which feels a bit like
having a urine infection
• About 7 out of 10 people want to pass urine more often than usual
• About 1 in 4 people have blood in their urine
• About 1 in 2 people have flu like symptoms for 24 to 48 hours
after each treatment
• About 1 or 2 out of 100 people have painful joints
If you have any of these symptoms, tell your doctor at your next appointment.
There is also a very small chance that some of the TB could get into your system and give you
TB symptoms such as
• Fever and chills
• Joint pain
• Feeling sick or vomiting
• Cough
• Skin rash
• Feeling extremely tired
It is important that you tell your doctor straight away if you have any of these symptoms
or have a high temperature for more than 48 hours. You may need treatment with anti TB
drugs and should not wait until your next appointment to let your doctor know.
Intravesical therapy
Doctors around the world are looking into using different substances for intravesical
therapy to see if they can find treatments that work better than chemotherapy and BCG.
They are looking at
• IL2 (Aldesleukin) and interferon
• Photodynamic therapy
Aldesleukin is called interleukin 2. It is a type of biological therapy drug. Biological
therapies are treatments that use natural body substances, or drugs that block them,
to treat cancer. Interleukin 2 is a protein made naturally in the body as part of the
immune response. So it is also called an immunotherapy. Now it can be made in the laboratory
in large quantities to treat cancer and other illnesses.
Photodynamic therapy treatment uses an anti cancer drug that only works when light shines
on it. It is called photodynamic therapy (PDT). Your doctor either puts the drug directly
into your bladder (through a catheter) or less commonly you may have it into your bloodstream.
After a few hours, you have a catheter put into your bladder again. The doctor fills your
bladder with salt water (saline). Then they shine a laser light at the bladder lining.
The light activates the drug to kill any cancer cells that are there. The treatment
works in 3 ways.
• directly kills the bladder cancer cells
• damages the blood vessels that bring food and oxygen to the tumour
• triggers your immune system to destroy the tumour
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