Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

Your recommended treatment plan will depend on whether your doctor feels that there is a low, moderate, or high risk of the cancer returning and/or spreading beyond the lining of your bladder. This risk is calculated using a series of factors. These include:

• the number of tumours that are present in your bladder,
• whether the tumours are larger than 3cm (1 inch) in diameter,
• whether you have had previous episodes of bladder cancer,
• whether the tumours are limited to your bladder lining, or whether they have started to spread to the tissue beyond the lining, and
• the grade of the cancer cells.

The grade of the cancer cells describes how aggressively they are likely to grow and spread, with low grade being the least aggressive and high grade being the most aggressive.

If the risk of your cancer returning and/or spreading is low, your recommended treatment plan will usually be surgery to remove the tumours followed by a course of chemotherapy.

If the risk of your cancer returning and/or spreading is moderate, you will be given a longer course of chemotherapy after surgery.

If the risk of your cancer returning and/or spreading is high, as well as surgery and chemotherapy, you will be given an additional medication called the Bacillus Calmette-Guérin (BCG) vaccine.

Surgery

The standard surgical treatment for non-invasive bladder cancer is known as a transurethral resection of a bladder tumour (TURBT). In most cases, a TURBT can be performed at the same time as a biopsy.

A TURBT is performed under general anaesthetic. The surgeon will use a cystoscope to find all the visible tumours and will then cut them away from the lining of the bladder using instruments that are passed down through the cystoscope.

Once the tumour(s) have been removed, any bleeding can be stopped using a mild electric current to cauterise (seal with heat) the remaining wound.

If you experience significant bleeding, a thin, flexible tube, known as a catheter, may be inserted into your urethra and directed up into your bladder. The catheter will be used to drain away any blood and debris from your bladder, and it may need to be kept in place for several days.

After having a TURBT, most people are able to leave hospital within 48 hours, and are able to resume normal physical activity within two weeks.

Chemotherapy

Once a TURBT is complete, you will be given one, or more, courses of chemotherapy. The first course of chemotherapy will be given immediately after surgery once you have recovered from the effects of the general anaesthetic.

A type of chemotherapy that is known as intravesical chemotherapy is used. It involves placing a liquid solution of chemotherapy medication directly into your bladder by way of a catheter. The solution will be kept in your bladder for about a hour before being drained away.

There may be some residue of the chemotherapy medication left in your urine, so when going to the toilet it is important not to splash yourself, or the toilet seat, with urine as it could irritate your skin. After passing urine, you should also wash the skin around your genitals with soap and water. Your cancer nurse will be able to provide you with more advice about these issues.

The advantage of this technique is that as the chemotherapy medication is only in your bladder, and because it is not injected into your blood (intravenous chemotherapy), you will not experience the side effects that are most commonly associated with chemotherapy, such as nausea, fatigue, and hair loss.

The most common side effect of intravesical chemotherapy is irritation and inflammation of the bladder lining. This can cause:

• a frequent need to urinate, and
• pain when urinating.

These side effects should pass within a few days.

If your cancer is low-risk, you should not require any additional treatment. However, if your cancer is medium or high risk, you will be given additional courses of chemotherapy, usually once a week, over the course of six weeks.

It is important that you use contraception while you are having intravesical chemotherapy because the medication that is used can temporarily affect the quality of a man’s sperm and a woman’s eggs, increasing the risk of birth defects.

Bacillus Calmette-Guérin (BCG) vaccine

The Bacillus Calmette-Guérin (BCG) vaccine is used to treat high-risk cases of non-invasive bladder cancer in order to reduce the risk of the cancer returning.

The BCG vaccine was originally designed to treat tuberculosis (TB) but it has also proved to be an effective treatment against bladder cancer. Exactly how the BCG vaccine works is still unclear. It appears to stimulate the immune system in such a way that the immune system begins to target and destroy any remaining cancer cells.

The BCG vaccine is administered in the same way as intravesical chemotherapy. A liquidised version of the vaccine is passed into your bladder. You will need to keep the vaccine in your bladder for two hours after which it is drained away.

The precautions regarding not splashing yourself, or the toilet seat, with urine also apply to the BCG vaccine.

Most people require six courses of treatment given weekly over the space of six weeks. Depending on your circumstances, maintenance therapy may also be recommended. This involves you receiving further doses of the BCG every six months, with a series of three weekly doses. Maintenance therapy usually lasts for three years.

Common side effects of the BCG include:

• a frequent need to urinate, 
• pain when urinating, and
• blood in your urine

Less common side effects include:

• a high temperature (fever) of above 39C (102.2F),
• skin rash, and
• a general sense of feeling unwell.

You should inform your doctor if the side effects become troublesome because additional treatments for them are available.

Related posts:

1. Bladder Cancer: Symptoms And Causes
2. Bladder Cancer: Diagnoses
3. Cervical cancer vaccine trial raises hope