Treatment of Stage I Bladder Cancer

Transurethral resection (TUR) is the most common form of treatment for Stage I bladder cancer.

• Transurethral resection (TUR), also known as transurethral resection of the bladder tumor (TURBT) - The urologist places a rigid cystoscope (thin lighted tube) called a resectoscope into the bladder through the urethra while you are under regional or general anesthetic. The resectoscope lets the urologist see into the bladder and remove the tumor using a wire loop at the end of the resectoscope. The surgeon can also burn the tumor off using a laser or high-energy electricity (fulguration).

In rare cases, Stage I bladder cancer is treated with partial or radical cystectomy:

• Cystectomy - Cystectomy is used to remove the diseased area by cutting through the bladder wall. Cystectomy can be partial or radical:
  
  
  • Partial or segmental cystectomy - The surgeon removes only the cancer and part of the bladder. This surgery is sometimes used for low-grade tumors that have invaded the wall of the bladder but are only found in one area of the bladder. Because only a part of the bladder is removed, patients can urinate normally after recovering from this surgery.
  • Radical cystectomy - If you have more than one area of cancer, you might have a radical cystectomy. In this operation, the surgeon removes the bladder and tissue around the bladder as well as any lymph nodes (small, bean-shaped collections of immune system cells that help fight infections) and nearby organs that contain cancer. For men, the prostate may also be taken out. For women, the surgeon might also remove the uterus (womb), ovaries, and a small portion of the vagina and fallopian tubes (which connect the ovaries and uterus).

After surgery, your doctor may use intravesical (local) chemotherapy or immunotherapy to treat tumors that could not be removed by surgery or to decrease the risk that the cancer will return. 

• Intravesical (local) chemotherapy - A urinary catheter (thin, flexible tube) is used to deliver the anticancer drugs directly into the bladder. These drugs can reach cancer cells near the bladder lining. Because the drugs do not usually spread throughout the body, this limits the unwanted side effects that can occur with systemic chemotherapy.
  
  

  The drugs used most often for intravesical chemotherapy for Stage I bladder cancer are:
  

  • Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. It stops the growth of cancer cells, causing them to die. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer you have.
  • Mutamycin^® (mitomycin) - Mitomycin belongs to a group of chemotherapy drugs known as antibiotics, but it acts like an alkylating agent. It blocks the cell from making DNA, which results in cell death. Mitomycin is given by an injection in a vein over 20 minutes every 6 to 8 weeks. The dose and how often you get the medicine depend on your weight, your blood counts, how well your kidneys work, and the type of cancer you have.
  • Thioplex^® (thiotepa) - Thiotepa belongs to the group of chemotherapy drugs known as alkylating agents. It stops the growth of cancer cells, causing them to die. Thiotepa is given by an injection in a vein or muscle or under the skin. It can also be given directly into the bladder. The dose depends on your weight and the type of cancer.
  
  
• Intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) - BCG is a bacterium that is given directly into the bladder through a catheter (thin, flexible tube). BCG irritates the inside of the bladder and this attracts your immune cells to the bladder to fight the tumor.  BCG is usually given once a week for 6 weeks. After that, some doctors recommend repeat treatment every 3 to 6 months.

Your doctor might also recommend internal radiation therapy (brachytherapy), or both internal radiation therapy and external beam radiation therapy, in combination with chemotherapy to reduce the risk that the cancer will come back.

• Internal radiation therapy (brachytherapy) - A small pellet of radioactive material is placed directly into the bladder through the urethra or an incision in the abdomen. You will stay in the hospital for several days during this treatment. This treatment is also known as interstitial radiation therapy.

• External beam radiation therapy (EBRT) - This focuses radiation from outside the body on the cancer. Most people are treated with EBRT 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. 

This content has been reviewed and approved by Myo Thant, MD.