Treatment overview for early (superficial) bladder cancer

Some people may only need surgery to cure their cancer. However, non-invasive bladder cancer can come back in the bladder lining and, in some people, it may start to grow into the muscle (invasive bladder cancer|). Because of this, you may be given treatment after surgery to reduce the risk of this happening.

Your doctor will discuss this with you and explain what the most appropriate treatment is for your situation.

Treatment after surgery

Depending on the risk of the cancer coming back, you may have the inside of your bladder treated with chemotherapy| or with a vaccine called BCG|.

During and after your treatment, you’ll have regular cystoscopies| to check the lining of your bladder. Any new tumours can usually be successfully removed with further surgery. Treatment with chemotherapy or BCG can also be given if the cancer returns.

Very occasionally, people with a very high risk of the cancer becoming invasive may be advised to have an operation| to remove the bladder (cystectomy). This is usually only suggested after other treatments have already been tried.

Planning your treatment

In most hospitals, a team of specialists will meet to discuss and agree on the plan of treatment they feel is best for you. This multidisciplinary team (MDT) will normally include:

• urologists, who are surgeons experienced in bladder surgery
• specialist urology nurses, who give information and support
• oncologists, who are doctors that have experience in bladder cancer treatment using chemotherapy, immunotherapy and radiotherapy
• pathologists, who advise on the type of cancer and its extent
• radiologists who analyse x-rays and scans.

Other staff are also available to help you if necessary, such as physiotherapists, counsellors and psychologists.

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

The advantages and disadvantages of treatment

For most people with non-invasive bladder cancer, surgery is done with the aim of curing the cancer or controlling it for many years. You may also be given treatment after surgery to reduce the risk of it coming back.

When you have been offered treatment that aims to cure the cancer, deciding whether to accept it may not be difficult. But some people may need to know more about the benefits of further treatments when weighed up against the side effects.

Your specialist will talk this over with you so that you know the advantages and any possible disadvantages.

Second opinion

Your MDT uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay 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 relative or friend with you. Have a list of questions ready, so that you can make sure your concerns are covered during the discussion.

Giving your consent

Before you have any treatment, your doctor will explain its aims. They will ask you to sign a form saying that you give 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 be given full information about:

• the type and extent of the treatment
• its advantages and disadvantages
• any significant risks or side effects
• any other treatments that may be available.

If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.

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

People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.

You can always ask for more time if you feel that you can’t make a decision when your treatment 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 don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.