Types Of Bladder Cancer
Bladder cancer can be described based on where it is found:
- non-muscle invasive the cancer has not spread to other layers of the bladder or muscle
- muscle-invasive the cancer has spread to other layers of the bladder, muscle or other parts of the body.
There are 3 main types of bladder cancer:
- urothelial carcinoma 80 to 90% of bladder cancers sometimes called transitional cell carcinoma
- squamous cell carcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive
- adenocarcinoma 1 to 2% of all bladder cancers. It is more likely to be invasive .
There are other, less common types of bladder cancer. Treatment for these may be different. Speak to your doctor or nurse for information about these types of cancer.
Is Bladder Cancer Curable
The likely outcome after treatment depends on the disease stage, the tumor type, and non-disease factors such as the patients age and health. As with most cancers, outcomes are best if the cancer is detected early. Superficial bladder cancer is highly treatable, but many patients develop new tumors even after successful treatment, so regular monitoring is important to enable early detection and further treatment as required. For information on the average survival for patients with different stages of bladder cancer, see Bladder cancer survival – the importance of early detection.
How Bladder Cancer Spreads
Bladder cancer usually begins in the cells of the bladder lining. In some cases, it may spread into surrounding bladder muscle. If the cancer penetrates this muscle, it can spread to other parts of the body, usually through the lymphatic system.
If bladder cancer spreads to other parts of the body, such as other organs, it’s known as metastatic bladder cancer.
Page last reviewed: 01 July 2021 Next review due: 01 July 2024
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Treatment For Invasive And Advanced Bladder Cancer
- Patients with bladder cancer that has grown into or beyond the bladder wall but has not spread beyond the pelvic region may be recommended to undergo cystectomy, with systemic chemotherapy given first as this can improve survival. Alternatively, patients may have TURBT followed by chemotherapy plus radiation to try to preserve the bladder.7
- For patients with metastatic bladder cancer , systemic chemotherapy is usually the first treatment. If chemotherapy stops working, subsequent treatments may include immunotherapy and targeted therapy, to try to slow disease progression and extend survival.
Is There A Risk Of Bladder Cancer After Bcg Treatment
Like most cancers, bladder cancer can potentially return after treatment. Statistically, cancer will recur in up to 40% of people who receive BCG treatment. Its important to note, however, that even if the cancer comes back, it may not progress.
Low-grade bladder cancer usually doesnt spread to other areas of your body. But people who have low-grade bladder cancer have a higher risk of developing other low-grade cancers throughout their lifetime.
Less often, aggressive bladder cancer can develop after BCG treatment. If this happens, cystectomy is usually recommended.
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Is Bcg Treatment Contagious
Because BCG contains live bacteria, precautions are necessary to prevent it from being passed to others.
Patients should go to the bathroom sitting down to reduce splashing and wash their hands thoroughly after urinating. Pouring bleach into the toilet after use may also prevent contamination.
Once home, a patient should drink plenty of liquids and avoid sexual contact with others for 24 hours.
Research has shown that BCG may also reduce the risk of contracting a respiratory tract infection, giving your immune system a boost. However, precautions are still necessary to stay healthy.
The care team will talk to the patient about what to expect and provide instructions to follow at home.
How Should I Prepare For Bcg Treatment For Bladder Cancer
Prior to BCG treatment, your healthcare provider will give you a list of specific guidelines to help you prepare. In general, you should avoid caffeinated beverages and diuretics for four hours before your appointment. When you arrive for your procedure, you should pee to ensure that your bladder is empty.
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New Treatments For Bladder Cancer: Targeted Therapy
Targeted therapies are designed to target features of cancer cells that differ from healthy cells, such as gene alterations or cell-surface proteins. Targeted therapies with FDA approval to treat advanced bladder cancer after previous therapies have stopped working include:
- a drug targeting the fibroblast growth factor receptor , for patients with mutations in the FGFR3 or FGFR2 gene3,4
- antibody-drug conjugates , where an antibody attaches to a target protein, releasing a cytotoxic drug that kills the cancer cell. 5
How Is Bladder Cancer Treated
Treatment for bladder cancer depends on the tumor characteristics and the disease stage, which identifies whether the tumor is superficial or invasive , and whether it has spread beyond the bladder. Depending on the stage and grade of disease most patients will have surgery, often followed by radiation therapy and medical treatment .
Treatment may be local or systemic :
- Local therapy means that medicine is delivered directly into the bladder via a catheter this is called intravesical treatment. Intravesical chemotherapy or immunotherapy can lower the risk of cancer returning.
- Systemic therapy is used to kill cancer cells that may have spread beyond the bladder. Chemotherapy, targeted therapy, and immunotherapy can all be given systemically, either intravenously or taken as a capsule or pill.
Several new treatments for bladder cancer such as immune checkpoint inhibitors and targeted therapies have become available in recent years.
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What To Expect During Bcg Treatment
First, make sure you havent had any fluids for four hours before the treatment. Right before you go into the treatment room your doctor or nurse will have you empty your bladder.
Youll lie on your back, and the medical professional will insert a catheter into your urethra and into your bladder, likely using some local numbing, and use this tube to infuse the treatment.
Once the treatment is infused, your doctor or nurse will remove the catheter. Theyll have you lie on your back, each side, and your stomach for 15 minutes each. The BCG mycobacteria needs to touch the bladder cancer cells to activate the immune system. Youll then be free to go but will need to hold off on peeing for another hour.
Verywell / Alex Dos Diaz
For at least six hours after your infusion, youll need to disinfect your pee to ensure none of the mycobacteria spread to anyone else. Pour an equal amount of bleach into the toilet after you pee and let it sit for 15 minutes before flushing.
You will likely need multiple BCG treatments. They may be given weekly for a few weeks, then less often for months or years to prevent cancer from coming back.
Catheterizable Continent Diversion Pouch
This is a reservoir of bowel with a stoma that is catheterizable for emptying the bladder. The urine is siphoned out of the urinary reservoir with a small catheter every four to six hours. The catheterizable pouch may require surgical repair at some point after surgery due to the wear and tear of frequent catheterization. This type of reconstruction is not performed on patients with a history of bowel disease.
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Selecting And Testing Gemcitabine
When Dr. Messing began research on gemcitabine as a possible way to reduce recurrences more than a decade ago, the drug was not widely used for bladder cancer. “We tried to pick an agent that we thought would be safe and effective,” he said.
The researchers decided to compare gemcitabine against placebo rather than mitomycin C, based on studies showing how infrequently patients received some form of chemotherapy following surgery despite guidelines recommending this approach.
“If the new procedure were adopted widely, we could spare patients a lot of suffering from repeated surgeries and save health care costs associated with those surgeries,” Dr. Messing said.
“Now that we have the results of the trial,” he went on, “we hope that patients and physicians will embrace this approach to treatment.”
After Treatment: Remission And The Risk Of Bladder Cancer Recurrence
People who have been treated for bladder cancer have unique monitoring needs due to the high risk of recurrence, even when diagnosed early. Doctors generally recommend a cystoscopy to examine the inside of the bladder and urethra every 3 to 12 months, depending on risk factors, for several years after bladder cancer treatment. If several years of surveillance have gone by and no cancer recurrence has been detected, a yearly cystoscopy may be enough, depending on the nature and severity of the original cancer.
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Bladder Reconstructions And Stomas
If you have had your bladder removed, the way you pass urine will change. There are several options that your treatment team will talk to you about:
- Urostomy is where doctors create a new hole in your abdomen called a stoma. Urine drains from the stoma to the outside of your abdomen into a special bag.
- Neobladder is where a new bladder made from your small bowel forms a pouch inside your body to store urine. You will pass urine by squeezing your abdominal muscles. You will also pass a small tube into the neobladder each day to help drain the urine.
- Continent urinary diversion is a pouch made from your small bowel inside your body to store urine. The urine empties through a hole called a stoma to the outside of your abdomen into a special bag.
A bladder reconstruction is a big change in your life. You can speak with a continence or stomal therapy nurse for help, support and information. You can also call Cancer Council . You may be able to speak with a trained Cancer Council volunteer who has had cancer for tips and support.
If you find it difficult to adjust after your bladder reconstruction, it may help to be referred to a psychologist or counsellor.
Note: If you have a stoma, you can join a stoma association for support and free supplies. For more information about stoma associations, visit the Australian Council of Stoma Associations.
Who Can Have This Treatment
BCG is appropriate for noninvasive and minimally invasive bladder cancers. It usually follows a procedure called transurethral resection of bladder tumor . Its intended to help prevent recurrence.
This treatment only affects cells inside the bladder. Its not useful for later stage bladder cancer that has spread into or beyond the bladder lining, or to other tissues and organs.
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Treatment For Advanced Bladder Cancer
If bladder cancer has spread to other parts of the body, it is known as advanced or metastatic bladder cancer. You may be offered one or a combination of the following treatments to help control the cancer and ease symptoms:
- systemic chemotherapy
- radiation therapy.
Immunotherapy uses the bodys own immune system to fight cancer. BCG is a type of immunotherapy treatment that has been used for many years to treat non-muscle-invasive bladder cancer.
A new group of immunotherapy drugs called checkpoint inhibitors work by helping the immune system to recognise and attack the cancer. A checkpoint immunotherapy drug called pembrolizumab is now available in Australia for some people with urothelial cancer that has spread beyond the bladder. The drug is given directly into a vein through a drip, and the treatment may be repeated every 2 to 4 weeks for up to 2 years.
Other types of checkpoint immunotherapy drugs may become available soon.
What Happens During Bcg Cancer Treatment
Before beginning BCG treatment, local anesthesia is given to numb the area and keep you comfortable. Next, your healthcare provider will place a catheter into your urethra and inject the liquid BCG solution into your bladder.
The BCG solution needs to come in contact with cancer cells to kill them. So, once the medication is injected, your healthcare provider will remove the catheter and ask you to lie on your back, stomach and both sides for 15 minutes each.
When the process is complete, youre free to leave your appointment. However, you should avoid peeing for at least one more hour.
How long do you hold BCG in your bladder?
Once the BCG solution is injected into your bladder, youll hold it for a total of two hours. After this point, youll be able to pee.
What does BCG do to the bladder?
When the BCG solution enters your bladder, your immune system cells begin to attack the cancer cells in your bladder.
BCG treatment schedule
The initial BCG cancer treatment occurs weekly for six weeks. This is called induction therapy.
If the treatment is working, your doctor may prescribe BCG maintenance therapy. Maintenance therapy is given once a week for three weeks at the three-, six- and 12-month marks. For some people, this may be continued up to three years.
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Treating Bladder Cancer That Progresses Or Recurs
If cancer continues to grow during treatment or comes back after treatment , treatment options will depend on where and how much the cancer has spread, what treatments have already been used, and the patient’s overall health and desire for more treatment. Its important to understand the goal of any further treatment if its to try to cure the cancer, to slow its growth, or to help relieve symptoms as well as the likely benefits and risks.
For instance, non-invasive bladder cancer often comes back in the bladder. The new cancer may be found either in the same place as the original cancer or in other parts of the bladder. These tumors are often treated the same way as the first tumor. But if the cancer keeps coming back, a cystectomy may be needed. For some non-invasive tumors that keep growing even with BCG treatment, and where a cystectomy is not an option, immunotherapy with pembrolizumab might be recommended.
Cancers that recur in distant parts of the body can be harder to remove with surgery, so other treatments, such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy, might be needed. For more on dealing with a recurrence, see Understanding Recurrence.
How Is Bcg Given
The combination of BCG and TURBT is the most effective treatment for high-risk non-muscle-invasive bladder cancer. BCG is given once a week for six weeks, starting 24 weeks after TURBT surgery. It is put directly into the bladder through a catheter. You may be asked to change position every 15 minutes so the vaccine washes over the entire bladder. This is usually done as a day procedure in hospital, and each treatment session takes up to two hours.
Your treatment team will tell you what safety measures to follow after you go home. This is because BCG is a vaccine that contains live bacteria, which can harm healthy people.
Let your doctor know of any other medicines or complementary therapies you are using, as they may interfere with how well the bladder cancer responds to BCG. For example, the drug warfarin is known to interact with BCG.
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Treatment Of Bladder Cancer By Stage
Most of the time, treatment of bladder cancer is based on the tumors clinical stage when it’s first diagnosed. This includes how deep it’s thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing , and a persons overall health and preferences, also affect treatment options.
Is There Any Preparation Involved
Its important that you follow your doctors instructions for what to do before and after the procedure. Tell your doctor about all the medications you take. Certain immunosuppressants, antimicrobial therapies, and radiation therapies can interfere with BCG treatment.
Youll be advised to limit your fluid intake for four hours prior to the procedure. You might be told to avoid caffeine for a few hours longer than that, because its a diuretic and could make things more difficult.
Youll be asked to urinate just before the procedure so youll be able to hold the medication in your bladder for several hours.
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Prognosis And Survival Rates For Bladder Cancer
When someone is diagnosed with bladder cancer, their doctor will give them a prognosis. A prognosis is the doctors opinion of how likely the cancer will spread and the chances of getting better. A prognosis depends on the type and stage of cancer, as well as the persons age and general health.
Bladder cancer can usually be effectively treated if it is found before it spreads outside the bladder.
If you have bladder cancer, your doctor will talk to you about your individual situation when working out your prognosis. Every persons experience is different, and there is support available to you.
What Is Bcg Treatment
Bacillus Calmette-Guerin treatment is a type of intravesical immunotherapy. This liquid drug is made from a strain of Mycobacterium bovis the same bacterium used to create the tuberculosis vaccine. When used in medicine, Mycobacterium bovis is weakened to reduce harm to your body.
BCG treatment is usually given after TURBT , which is a bladder surgery to remove any visible cancer.
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Is Bcg Treatment A Form Of Chemotherapy
BCG is an immunotherapy that helps the bodys immune system fight off cancer cells. Chemotherapy, on the other hand, uses anti-cancer medications to directly kill the cancer cells.
For most patients, BCG treatment usually begins with two-hour sessions once a week for six weeks. If the body responds to the treatments, more sessions may be scheduled.