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Early (superficial) bladder cancers are usually small growths (papillary cancers) and there may be more than one. The cancer or cancers can be usually removed surgically, using a cystoscope (see diagnosis).
Surgery is the main treatment for early bladder cancer. It may be the only treatment that is needed or it may be combined with drug treatment given into the bladder.
Before surgery you will have a blood test to check your general health. You will also have a chance to discuss the surgery with a specialist nurse or a doctor. You’ll have a medical examination to make sure that you are fit enough to have an anaesthetic.
You will be admitted to the surgical ward on the day of surgery, or the day before. The anaesthetist will talk to you about your operation and ask you to sign a consent form. A research nurse may ask you for permission for blood samples and some of the tissue taken at the time of surgery to be kept and used for research. If you agree to this, you will be asked to sign a second consent form.
You will be given a general anaesthetic and a cystoscope will be inserted into the bladder. The tumour is cut out or burnt off (cauterised), using a mild electrical current. This procedure is known as a transurethral resection of a bladder tumour.
Transurethral means through the fine tube (urethra) which is connected to the bladder (see diagram of the bladder). The whole procedure is done in this way and several tumours can be treated at the same time, if necessary. You won’t be left with any scar because there’s no wound.
The operation usually takes from 20 minutes to an hour. You may be given chemotherapy into your bladder immediately after surgery.
When you go back to the ward you will have a thin, flexible tube (a catheter) in your bladder, which drains your urine into a bag. It may make you feel as though you want to pass urine. Your urine will be bloodstained at first. Large bags of fluid may also be used to flush out the bladder continuously. This is to make sure that clots of blood do not form and block the urethra.
Once you are drinking normally and your urine looks clear, the catheter will be taken out. This is not painful but may feel a little uncomfortable. Once your catheter has been removed and your urine is no longer bloodstained, you will be allowed to go home. This is usually about 2–3 days after the operation.
Removing early bladder cancers is a safe procedure. However, it can have some risks. These are outlined below.
Urine infection Between 5–10 out of every 100 patients (5–10%) may get a urine infection. This may be while they are still in hospital or after they go home. Signs of an infection include: feeling cold, shivery, hot or sweaty; feeling generally ill; or your urine becoming smelly or cloudy. If you think you may have an infection, you can take a urine sample to your doctor for testing.
Bleeding for more than a few days occurs in up to 5 out of 100 patients (5%) and a blood transfusion may be needed. If the bleeding does not stop on its own, another operation to stop the bleeding may need to be done under anaesthetic.
You may find that you have some further bleeding about 10–14 days after the operation to remove your cancer. This usually stops on its own after a couple of days. If the bleeding lasts for longer than this, or if you can see clots of blood, get in touch with your doctor.
Damage to the bladder There is a very small risk of a hole (perforation) being made in the bladder during surgery. If this happens it can usually be managed by having a catheter in the bladder (for about a week to 10 days) to drain the urine and allow the hole to heal.
If the hole does not heal in that time, you may need to have an operation to seal it. This involves making a cut in the abdomen. Your doctor or nurse will explain this procedure if it is needed.
After your operation your doctors will know more about the stage of your cancer. This information along with the grade of your cancer helps them decide on the most appropriate treatment for you.
You may be advised to have further treatment with chemotherapy or BCG to reduce the chances of the cancer coming back (recurring) or growing into the muscle (becoming invasive).
After your surgery you may be given chemotherapy directly into your bladder to reduce the risk of your cancer coming back in the bladder. When chemotherapy is given directly into your bladder it is described as intravesical.
Chemotherapy works by destroying cancer cells. When it’s given into the bladder the drug comes into direct contact with any cancer cells in the lining of the bladder. Because it’s given into the bladder and not through a vein (into the bloodstream) you won’t get side effects like feeling sick or hair loss, which people usually associate with chemotherapy. Hardly any of the drug is absorbed into the bloodstream which means that it doesn’t affect the rest of the body.
Most people with early bladder cancer will have a one-off treatment of chemotherapy into the bladder. This is usually given a few hours after your operation to remove the bladder cancer. Some people only have one treatment while others go on to have a course of treatment. People with low grade early bladder cancer won’t usually need any further treatment. If you have a moderate risk of your cancer coming back in the bladder you will usually have a course of chemotherapy into the bladder. This can include people who have:
Treatment is usually given once a week for about six weeks.
If you’re having chemotherapy into your bladder after surgery you’ll already be in hospital and will have a catheter (small tube into your bladder) in place. The treatment is usually given a few hours after the surgery. It may be delayed until the following day if you have a lot of blood in your urine.
After this, if you are having more chemotherapy, it will be given to you in the hospital outpatient department. You can go home as soon as it’s finished. It might be a good idea to ask someone to collect you, particularly the first time.
You’re usually asked to limit the amount you drink before your treatment. If you drink too much before treatment your bladder may feel uncomfortably full. Drinking less also helps to increase the concentration of the chemotherapy drug in your bladder. If you normally take water tablets (diuretics) take them later in the day after your treatment. Let your doctor know about any other medicines you are taking. You won’t be given chemotherapy if you are unwell or have an infection in your urine. Your nurse or doctor will give you more advice about preparing for your treatment.
You’ll have a fine tube (catheter) put into your bladder. Your doctor or nurse will then put the chemotherapy drug (a liquid) directly into your bladder through the catheter. The drugs that are most commonly used are mitomycin-C and epirubicin. The catheter is then usually removed.
Usually you’ll be asked to try not to pass urine for at least an hour after the drug has been put into your bladder. This can be difficult but it’s to give the treatment time to work. Sometimes the catheter is left in and clamped to keep the chemotherapy in your bladder until your treatment is over. You can walk around during this time. When the treatment is finished you can go to the toilet or, if you have a catheter, the chemotherapy drug will be drained into a urine bag before the catheter is removed.
After treatment there are some precautions you’ll need to take to protect yourself and others from coming into contact with the chemotherapy drug. To avoid splashing urine on the toilet seat it might be easier for men to pass urine sitting down.
You’ll be asked to wash the skin in your genital area carefully with soap and water after you pass urine. This is to make sure any of the chemotherapy drug that may have splashed onto your skin is then wiped off. It’s also important to wash your hands afterwards. Your nurse or doctor will give you more advice about this.
The following side effects are due to inflammation of the bladder lining (cystitis):
These side effects should settle down within a day or two. Drinking lots of fluids will help ease the irritation. You might find it helpful to take mild painkillers. Occasionally some people get a red skin rash on their hands and feet. Let your nurse or doctor know if this happens.
If your side effects don’t improve or you have a raised temperature and your urine is smelly (possible signs of a urine infection) get in touch with your doctor straightaway.
It isn’t advisable to become pregnant or father a child while having chemotherapy drugs to treat bladder cancer, as they may harm the developing foetus. It is important to use effective contraception during your treatment. You can discuss this with your doctor or specialist nurse.
Men should use a condom during sex for the first 48 hours after chemotherapy. If you are a woman having the treatment your partner should use a condom. Using a condom will protect your partner from any of the drug that may be present in semen or vaginal fluid.
BCG is a vaccine which is used to prevent tuberculosis (TB). But it’s also a helpful treatment for some early bladder cancers. When BCG goes directly into the bladder the treatment is described as intravesical. BCG is a type of immunotherapy. Immunotherapy stimulates the body's immune system to destroy cancer cells. Doctors aren’t sure exactly how BCG works. It seems that the vaccine makes the bladder react in a way that triggers the body's immune system to get rid of cancer cells in the bladder.
BCG is usually given to people with early bladder cancer who have a high risk of the cancer coming back and of growing into the muscle (invasive). This can include people who have:
BCG stops the cancer from coming back in the bladder and also reduces the chances of it spreading into the muscle (becoming invasive).Your specialist will explain why BCG is the most appropriate treatment for you.
You will usually have your treatment once a week for six weeks. If your BCG treatment is working well for you it can be given every six months, once a week for three weeks (called maintenance therapy).
Maintenance therapy can continue for up to three years. Your specialist will talk to you about how long your treatment will go on for.
BCG treatment is given to you in the hospital outpatient department. It takes up to three hours and you can usually go home as soon as it’s finished. It might be a good idea to ask someone to collect you, particularly the first time.
Unlike chemotherapy into the bladder, BCG treatment is never given immediately after surgery to remove bladder tumours. There needs to be a delay usually of at least two weeks after surgery, before you can have it. You won’t be given treatment with BCG if you are unwell or have an infection in your urine.
You’re usually asked to limit the amount you drink before your treatment. This will help to increase the concentration of BCG in your bladder. Drinking too much before your treatment may make your bladder feel uncomfortably full. If you normally take water tablets (diuretics) take them later in the day after your treatment. Your nurse or doctor will give you more advice about preparing for your treatment.
You’ll have a fine tube (catheter) put into your bladder. Your doctor or nurse will then put the vaccine (a liquid) directly into your bladder through the catheter. You will need to try not to pass urine for two hours afterwards. This can be difficult but it’s to give the treatment time to work. Sometimes the catheter is left in and clamped to keep the BCG in your bladder for the next two hours. You can walk around during this time. When the treatment is over you can go to the toilet (if you don't have a catheter). If you have a catheter the BCG will be drained into a urine bag before the catheter is removed.
After your treatment there are some precautions you’ll need to take. This is because BCG is a live vaccine and other people shouldn’t be exposed to it.
For the next six hours, you’ll need to avoid your urine splashing on the toilet seat and getting any urine on your hands. It might be easier for men to sit down when they’re using an ordinary toilet although using a stand up urinal should be alright. The main thing is to avoid splashing urine and spreading the vaccine. You will also be asked to put undiluted bleach into the toilet bowl to destroy any live vaccine and leave it for 15 minutes until you flush. Your nurse or doctor will give you more advice about this.
Because BCG goes directly into the bladder most of the side effects are linked with the bladder. They usually go away within one to two days after your treatment. The most common ones are:
These side effects should settle down within a day or two. If they don’t get better contact your doctor. Drinking lots of fluids can help flush the drug out of your bladder and reduce some of these effects. Taking simple painkillers can also help.
Rare side effects can include a continuing high temperature (fever), pain in your joints and a cough. If you have any of these symptoms, or if you feel generally unwell, contact your doctor immediately. These symptoms could be a sign of a more serious infection (due to BCG) that needs to be treated immediately. If this happens you’ll be treated with the same drugs (antibiotics) that are used to treat TB.
Men should use a condom during sex for the first 48 hours after their treatment. If you are a woman who has had BCG treatment then your partner should use a condom. Using a condom will protect your partner from any vaccine present in your semen or vaginal fluid.
We don’t know how BCG may affect a developing foetus so it’s not advisable to become pregnant or father a child while having it. It is important to use effective contraception during your treatment and for six weeks afterwards. You can discuss this with your doctor or specialist nurse.
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