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Sister Lynsey Robson, Urology Nurse Specialist 0191 233 6161 and ask for extension 26115

There are several types of bladder cancer:

• Superficial bladder cancer (tumours growing on the lining of the bladder)
• Carcinoma–in–situ (CIS)
• Muscle invasive bladder cancer
• Metastatic or advanced bladder cancer – cancer that has spread beyond the bladder

Superficial bladder tumours

Most (70%) bladder cancers are superficial and look like tiny sea anemones growing on the inside lining of the bladder. They are sometimes known as papillary tumours; in the past they were sometimes called papillomas or bladder warts. There may be more than one tumour present.

Treatment of superficial tumours

They can be completely removed by cutting them off under anaesthetic using a cystoscope and a cautery loop. This operation is called transurethral resection of bladder tumour (TURBT). The tumours are then sent for microscopic examination. Small tumours are removed completely by this treatment but unfortunately the bladder may develop further tumours over time. It is therefore very important to have regular bladder inspections (cystoscopies) every few months to check that the bladder remains healthy and tumour free.

Your Urologist will advise you how often you will need to come to hospital for cystoscopies once he/she has looked in your bladder and seen the laboratory results from your biopsies.

Intravesical drug treatment

In addition to the removal of the tumour(s) and regular cystoscopies, you may be asked to attend hospital as an out-patient to have intravesical chemotherapy or immunotherapy (BCG). Studies have shown that the likelihood of developing further tumours is reduced by washing the bladder out with one of several drugs. This treatment may be given just once after your cystoscopy, or on a weekly basis for 3 or 6 weeks depending on what is most appropriate for YOUR bladder.

Out-patient treatment is given via a small tube (catheter) gently passed through the urethra into the bladder after the use of local anaesthetic. You are asked to hold the drug in your bladder for 1-2 hours (depending on the drug) before emptying your bladder in the normal way and going home. If appropriate, we can arrange for you to have this treatment in your own home.

While most people complete their treatment with no problems, it may help to know that the following side effects CAN occur and what to do if this happens.

You may need to empty your bladder more often, and it may be uncomfortable when you do. You may develop a rash on your hands, or experience sweats or shivers on the evening of your treatment. You will be given more detailed information about your particular treatment, but it is important that you drink plenty of fluids (something every hour) after treatment and contact the hospital if you have any concerns.

Follow up

For most patients the longer term future will involve regular but less frequent cystoscopies, and occasional admissions to hospital for extra treatment.

Carcinoma in situ (CIS)

This is a particular type of bladder cancer in which the lining of the bladder appears inflamed and is covered with rather abnormal cells. This can develop into a more invasive tumour if it is left untreated.

Your Urologist may discuss several types of treatment with you. You may need to come back a little earlier (at about 6 weeks) for a repeat resection of the area of the tumour, and it is likely that you will be offered an initial 6 weeks of BCG treatment into your bladder followed by regular BCG treatment. Your Urologist may recommend removal of the bladder in some circumstances.

In conclusion, your treatment options will always be discussed with you, and the most appropriate course chosen only after you have had the opportunity to consider your options and ask any questions.