The treatment for bladder cancer depends on the type of cancer and the stage and grade. In most hospitals, a team of specialists will meet to discuss and agree on the plan of treatment they feel is best for your situation. This multidisciplinary team (MDT) will normally include:

• urologists (surgeons who are experienced in bladder surgery)
• specialist nurses, who give information and support
• oncologists – doctors who have experience in bladder cancer treatment using chemotherapy, radiotherapy and biological therapies
• radiologists, who help to analyse x-rays
• pathologists, who advise on the type and extent of the cancer.

Other staff will also be available to help you if necessary, such as:

• physiotherapists
• counsellors and psychologists
• social workers.

Your doctors will discuss with you what the best treatment is for your particular situation. If you have any questions about your treatment, don’t be afraid to ask your doctor or the nurse looking after you. It often helps to make a list of the questions you want to ask and to take a close friend or relative with you to help you remember what is discussed.

If two treatments are equally effective for your type and stage of cancer, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might have, so that you can decide what is the right treatment for you.

Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It’s often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment. However, it can be helpful to let the staff know your concerns so that they can give you the best advice.

Usually a number of cancer specialists work together as a team and they use national treatment guidelines to decide on the most suitable treatment for a patient. Even so, you may want to have another medical opinion. Either your specialist or GP will be willing to refer you to another specialist for a second opinion, if you feel it will be helpful. Getting a second opinion may cause a delay to the start of your treatment, so you and your doctor need to be confident that it will give you useful information.

If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and to have a list of questions ready so that you can make sure your concerns are covered during the discussion.

Carcinoma in situ, or CIS, is a very early bladder cancer. As it can be quickly growing, the treatment may be more intensive than for other types of early bladder cancer. The usual treatment is removal of the area of CIS by surgery. The surgery is followed by treatment of the inside of the bladder (intravesical therapy) with either chemotherapy or BCG. This can get rid of the CIS in up to 60% (6 in 10) of people.

If the CIS does not go away completely or comes back after treatment, further treatment with surgery, chemotherapy or BCG will be needed. Your doctor can talk to you about the most appropriate treatment in your situation.