Treatment options for non muscle invasive bladder cancer

This page is about the treatment options for non muscle invasive bladder cancer.

We have a separate section about treating muscle invasive bladder cancer. Muscle invasive means the cancer has spread into or through the muscle layer of the bladder. 

Find out more about treating muscle invasive bladder cancer

Deciding which treatment you need

Your doctor will talk to you about your treatment, its benefits, and the possible side effects. 

A team of doctors and other professionals discuss your treatment plan. They are a multidisciplinary team (MDT). The MDT will discuss your care if you have a high risk non muscle invasive bladder cancer. Or if your bladder cancer comes back (relapses).

The MDT includes:

• a urologist - a surgeon specialised in treating bladder problems

• an oncologist – a cancer specialist

• a radiologist – a doctor specialising in reporting x-rays and scans

• a specialist urology nurse – also called a clinical nurse specialist (CNS)

• a pathologist - a doctor who specialises in looking at cells under the microscope

The treatment you have depends on:

• the size of your tumour (T stage)

• what the cells look like under a microscope (grade)

• whether you have any carcinoma in situ (CIS)

• how many tumours there are

• how wide the tumour is (diameter)

• whether this is your first diagnosis, or it has come back (a recurrence)

After surgery, the doctor sends samples (biopsies) of the cancer to the laboratory. They check the type and grade of the cancer cells to see if your early bladder cancer is:

• low risk

• intermediate risk

• high risk 

These risk groups describe how likely it is that the cancer will come back or spread after treatment. Your risk group helps the doctor decide what further treatment you may need.

Find out more about risk groups for early bladder cancer

Treatment overview

The main treatments for non muscle invasive bladder cancer are:

• surgery

• chemotherapy into your bladder

• a vaccine called BCG into your bladder

Surgery

Everyone has surgery to remove the cancer from their bladder lining. This operation is called trans urethral resection of bladder tumour (TURBT). You may have this surgery during or after tests to diagnose the cancer.

Find out more about having a TURBT

Some people with high risk bladder cancer need to have surgery to remove their bladder. This operation is called a cystectomy.

Find out about surgery to remove your bladder

Treatment into your bladder

You might have chemotherapy into the bladder (intravesical chemotherapy) after your surgery. This lowers the risk of the cancer coming back.

Read about having chemotherapy into your bladder

Or, you might have a vaccine called BCG into your bladder.

Find out about having BCG into your bladder

Treatment by risk group

Your doctor will tell you whether your non muscle invasive bladder cancer is:

• low risk

• intermediate (moderate) risk

• high risk

Follow up

After treatment, your specialist keeps a close eye in case the cancer comes back.

You have regular cystoscopies for some years. How often you have these depends on your bladder cancer risk group.

Find out about follow up for the different risk groups

If your bladder cancer comes back

The surgeon can remove the growths with a cystoscopy again. This happens if stage Ta or T1 bladder cancer comes back after treatment.

Your specialist takes more ​biopsies​ to check that the cancer is still at an early stage. If it is, you usually have ​chemotherapy​ or ​BCG​ treatment into the bladder. You then go back to having regular cystoscopies to check your bladder. Every 3 to 4 months you have scans to check your ​chest, tummy (​abdomen) and ​pelvis, for up to 2 years. This is usually a CT scan but can be a ​bone scan​ or ​MRI scan.

Your doctor might suggest you have more intensive treatment such as surgery to remove your bladder (cystectomy). They might recommend this if:

• the cancer cells are grade 3 (the cancer cells look very abnormal)

• the cancer is at a more advanced stage than before

• ​you have carcinoma in situ (CIS)​ that has come back after treatment into the bladder

Find out about treatments for non muscle invasive and muscle invasive bladder cancer

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Read more about clinical trials for bladder cancer