What is the treatment for superficial bladder tumours?

Removal of the tumour
Most superficial bladder tumours are removed by a specialist with the aid of a cystoscope. This is called 'Transurethral resection - TUR' as the tumour is removed via a cystoscope which is passed up the urethra. It does not involve an operation to cut into the bladder. Thin instruments can be passed down a side-channel of the cystoscope to remove the tumour.

Chemotherapy / Immunotherapy
Following a TUR, unless the tumour is in the very early stage, you may also be advised to have a course of 'intravesical chemotherapy'. This involves inserting a liquid which contains a chemotherapy drug inside the bladder for 1-2 hours. This is done by using a catheter and is usually repeated once a week for several weeks. This has been shown to reduce the chance of recurrence of the tumour. The most commonly used drug is called BCG. This is actually a vaccine which is used to prevent TB. It is not clear how it works for bladder tumours, but it may stimulate the immune system in some way to clear any abnormal cells in the bladder lining. So, strictly speaking, treatment with BCG is 'immunotherapy'.

Repeat cystoscopies
After a superficial tumour is removed, you will need a cystoscopy every so often. A recurrence of a tumour occurs in some cases, and routine 'check cystoscopies' will detect these at an early stage. If one recurs, it can be treated again. The time interval between check cystoscopies is every 3-4 months at first but may become longer if the bladder remains free of tumour at each check. You may need a check cystoscopy every now and then for several years to make sure the tumour has not returned.

What are the treatment options for muscle invasive bladder tumours?

Treatment options which may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), and your general health.

You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type of cancer.

You should also discuss with your specialist the aims of treatment. For example:

• Treatment may aim to cure the cancer. Some bladder muscle invasive cancers can be cured, particularly if they are treated in the early stages of the disease. (Doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If you are 'in remission', you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.)
• Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
• Treatment may aim to ease symptoms. If a cure is not possible, treatments may be used to reduce the size of a cancer which may ease symptoms such as pain. If a cancer is advanced then you may require treatments such as painkillers or other treatments to help keep you free of pain or other symptoms.

Surgery
An operation to remove the bladder is the most common treatment. This is a major operation. Before surgery you need a full discussion with a surgeon to understand the implications of the operation planned. For example, you will need an alternative way of passing urine if you have your bladder removed. One way for this is by a 'urostomy'. This is where a surgeon uses a technique to arrange a system for urine to drain into a bag which you wear on the outside of your abdomen. An alternative operation may be possible where the surgeon creates an artificial type of bladder from a part of the gut.

Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, if the passage of urine is blocked by a tumour then placing a catheter or other techniques may be appropriate.

Radiotherapy
Radiotherapy is sometimes used instead of surgery. Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (There is a separate leaflet which gives more details about radiotherapy.)

Chemotherapy
Prior to surgery or radiotherapy, a course of chemotherapy may be advised. This is called 'neoadjuvant chemotherapy'. Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying. (There is a separate leaflet which gives more details about chemotherapy.) Chemotherapy used before surgery may improve the outlook (prognosis). In some cases a course of chemotherapy is given following surgery.

What is the prognosis (outlook)?

• Superficial bladder tumours. There is a good chance of a cure with treatment. Also, check cystoscopies can often detect recurrences early and treatment can be repeated as necessary.
• Muscle invasive bladder tumours. A cure is less likely than with a superficial tumour. As a rule, the earlier the stage of the tumour, the better the chance of a cure with the treatments listed above. However, treatment can often slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

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