Superficial Bladder Cancer

Superficial bladder cancer is also called non-muscle invasive bladder cancer. This type of bladder cancer is found on the surface of the inside lining of the bladder. It is the most common type of bladder cancer, and is found in about 75% of new patients with bladder cancer. Patients are often found to have this kind of bladder cancer because of blood in the urine, problems passing urine, or irritation when they urinate. The blood in the urine can be seen by the patient (red urine with or without clots) or can be found by a doctor on a routine check of the urine in the office. Superficial bladder cancer is found in both men and women. In women, symptoms related to bladder cancer are sometimes mistaken for urinary tract infections, and the diagnosis of the bladder cancer is delayed. Bladder cancer is related to a history of smoking, but other factors can cause the cancer including job related and environmental exposures.

Fortunately, superficial bladder cancer is highly treatable. The initial step is to find the cancer. When cancer is suspected, patients have a CT scan to look for problems in the kidney, ureter (tube between the kidney and bladder), and the bladder. They then have a cystoscopy in the doctor’s office. The cystoscopy uses a small flexible telescope to look through the urethra (tube the urine goes through to get out of the bladder) into the bladder. The bladder is then carefully examined. Some very small bladder cancers can be removed and treated in the office with this flexible telescope. Most bladder cancers need to be removed in the operating room with the patient under anesthesia. For most patients, a single dose of chemotherapy is given inside the bladder after the tumor has been removed in the operating room to keep the tumor from coming back. After the tumor is removed, the pathologist looks at the tumor under the microscope. Based on the results from the pathologist further treatment may be needed.

Treatments for superficial bladder cancer are based on the results of the pathologic analysis. The main factor used to see if further treatment is needed is how deep into the bladder wall the cancer has grown. This gives the stage of the cancer.

Cancer Stages

Ta: The most common superficial bladder cancer is stage Ta. This tumor looks like a cauliflower in the bladder, and it does not grow into any of the layers of the bladder. Further treatments for single stage Ta tumors are usually not needed. Patients do need to come back for regular cystoscopy to make sure the tumor does not come back. In patients with tumors that come back, or patients with many of these tumors at the initial surgery, medicine can be given inside the bladder to prevent cancer from coming back. Stage Ta cancers do come back with some regularity, but they rarely change into cancers that can grow into the bladder wall or go to other parts of the body.

T1: A cancer that has grown into the top layer of the bladder (called the lamina propria) but not into the muscle is a T1 cancer. These cancers have the potential to come back and also to grow into the muscle of the bladder. When a T1 bladder cancer is found, the first step is often to look inside the bladder again after about 4 weeks and remove further tissue from the area where the tumor was located. If no invasion into the muscle is found, most patients with stage T1 bladder cancer undergo treatment with a medicine called BCG. This medicine is given weekly into the bladder starting about 1 month after the tumor was removed. It helps to prevent the tumor from coming back and helps prevent development of muscle invasive disease. About 6 weeks after completing the BCG, the doctor will do a cystoscopy again to make sure all of the cancer is gone. Some patients do not respond to this medication, and sometimes need to have their bladder removed. Most patients do respond to the medication. They then go on to have maintenance BCG given at 3 month then 6 month intervals. This type of therapy has been shows to work better than just a single course of BCG. Also, some more aggressive kinds of T1 bladder cancer exist that need to be treated with chemotherapy or removal of the whole bladder. These types of bladder cancer include small cell cancer, micropapillary cancer and cancers with lymphovascular invasion.

CIS: Carcinoma in situ (CIS) is often seen as a red, velvety patch in the bladder. This type of cancer grows on the surface of the bladder. It has a high risk of changing into disease that can invade into the muscle of the bladder wall. After diagnosis of CIS with biopsy, treatment starts about 4 weeks later with BCG. The medication is given inside the bladder once per week for 6 weeks. The bladder is checked again by cystoscopy and with a special urine test called cytology about 6 weeks after the last BCG dose. If the tumor has cleared, patients are started on maintenance BCG to prevent the CIS from recurring. If the CIS is still present, a second six-week course of BCG is given. If the CIS is not treated with the second course of BCG, patients may need to consider having the bladder removed because of the high risk of the cancer changing into disease that can spread to other parts of the body. Fortunately, most patients have a good response to BCG therapy.

More information on bladder cancer treatment at Siteman Cancer Center.