What treatment will I be offered?
Treatment options depend on how advanced the cancer is and usually differ between early stage, non-muscle-invasive bladder cancer (NMIBC) and more advanced muscle-invasive bladder cancer.
Your treatment plan will be based on the risk of the cancer returning or spreading beyond the lining of your bladder, which is calculated using a series of factors, including:
- the number of tumours present in your bladder
- whether the tumours are larger than 3cm (1 inch) in diameter
- whether you’ve had bladder cancer before
- the grade of the cancer cells
Who will be treating me in hospital?
All hospitals use multidisciplinary teams (MDT) to treat bladder cancer. These are specialists that work together to make decisions about the best way to proceed with your treatment.
Team members may include:
- a urologist – a surgeon who specialises in treating conditions affecting the urinary tract
- a clinical oncologist – a specialist in chemotherapy and radiotherapy
- a pathologist – a specialist in diseased tissue
- a radiologist – a specialist in detecting disease using imaging techniques
What are the treatments for NMIBC?
Low-risk – Treated with transurethral resection of a bladder tumour (TURBT)
Intermediate-risk – Course of at least 6 doses of chemotherapy
High-risk – A second TURBT; possibly a CT or MRI scan; a course of Bacillus Calmette-Guérin (BCG) treatment (using a variant of the BCG vaccine); or an operation to remove your bladder (cystectomy)
What is TURBT?
Low-risk non-muscle-invasive bladder cancer is treated with transurethral resection of a bladder tumour (TURBT). This procedure may be performed during your first cystoscopy, when tissue samples are taken for testing (see NHS UK Bladder Cancer).
TURBT is carried out under general anaesthetic. The surgeon uses an instrument called a cystoscope to locate the visible tumours and cut them away from the lining of the bladder. The wounds are sealed (cauterised) using a mild electric current, and you may be given a catheter to drain any blood or debris from your bladder over the next few days.
After surgery, you should be given a single dose of chemotherapy, directly into your bladder, using a catheter. The chemotherapy solution is kept in your bladder for around an hour before being drained away.
Most people are able to leave hospital less than 48 hours after having TURBT and are able to resume normal physical activity within 2 weeks.
Will I need chemotherapy?
People with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least 6 doses of chemotherapy (see NHS England Bladder Cancer). The liquid is placed directly into your bladder, using a catheter, and kept there for around an hour before being drained away.
You should be offered follow-up appointments at 3, 9 and 18 months, then once every year. At these appointments, your bladder will be checked using a cystoscopy. If your cancer returns within 5 years, you’ll be referred back to a specialist urology team.
Why might I need BCG and EMDA® Mitomycin-C Treatment?
If you are a High-Risk patient, your doctor may suggest a further treatment to help stop cancer cells from recurring. This further treatment, called Intravesical Chemotherapy, is the most commonly used chemotherapy for treating NMIBC.
The treatment, using a drug called Mitomycin-C, is administered directly into the bladder (Intravesical) using a small electric current to improve the effectiveness.
What is Mitomycin-C?
Mitomycin-C is a purple solution that can destroy cancer cells. It attacks cancerous cells when put into the bladder but does little damage to your normal, healthy bladder lining. It is a chemotherapy drug, installed directly into your bladder instead of being injected into your veins. This way you will not get the side effects often associated with chemotherapy, such as hair loss, nausea and vomiting.
What is EMDA® Treatment?
EMDA® or Electromotive Drug Administration is a non-invasive method of enhancing local drug penetration (Mitomycin-C) across the urothelium of the bladder. The EMDA® Physionizer Current Generator uses a small electric current to accelerate and actively transport ionized or non-ionized molecules, inside the drug, into the tissue. The two main principals in this treatment are:
- Iontophoresis – transport of ionised molecules into the tissue by applying a current across a solution containing the ions
- Electro-osmosis – transport of non-ionised solutes associated with the bulk transport of water
Improvement in the accumulation of Mitomycin-C in bladder tissue at greater depths has been proven in clinical trials using EMDA®.