In-bladder treatments
This page describes different types of treatments for bladder cancer which occur inside the bladder. These are TURBT, BCG, and mitomycin.
You are probably reading this because you or a loved one is about to have treatment for bladder cancer. You will have lots of questions and it is a good idea to read up about the procedure beforehand so you know what to expect and what further questions to ask. These pages based on our information booklets include straight-forward explanations. You can download our guides for extra tips from patients who have had procedures themselves at the bottom of this page.
We also have pages about bladder removal (surgery) and whole-body treatments (such as chemotherapy / radiotherapy). The treatment you receive will depend on your detailed diagnosis. Please speak to your treatment team if you are unsure about the treatment options you have been given.
More information on both TURBTs and BCG Treatment along with tips from other patients, are available in our patient information booklets (see link at the bottom of this page).
If you have any questions, please don’t hesitate to contact our helpline team or visit our forum which can answer general questions too. You are not alone. We are here to support you however we can.
If you find the medical diagrams daunting or hard to understand, chat through them with your Cancer Nurse Specialist.
1. TURBT
A TURBT is given to patients when further investigation is needed or to help make a full diagnosis. It can also be given as a treatment in a low-stage or early case of bladder cancer.
This is a procedure to take a sample (known as a biopsy) of some of the abnormal cells or to remove any abnormal tissue or cancerous cells, if possible. TURBT stands for Transurethral Resection of Bladder Tumour.
The advantage of this procedure is that it can be performed repeatedly at minimal risk to the patient and with excellent results.
There is a less than 10% risk of infection or injury to the bladder, and both are easily correctable if they do occur.
What happens
A TURBT is performed in the same way as a cystoscopy. It is an ‘incision-less’ surgery. It is usually done as a day or overnight case in your local hospital under either a general anaesthetic or a spinal block.
The instrument used to take the sample or to remove the tumour during the TURBT is called a resectoscope and, like the cystoscope, it is introduced through the urethra into the bladder.
Attached to this scope is a small, electrified loop of wire, which is moved back and forth through the tumour to cut away and remove the abnormal tissue. Electricity is used to seal off any bleeding vessels. This is sometimes called electro-cauterisation or fulguration.
After surgery, a single dose of chemotherapy is often given directly into the bladder, using a catheter. The solution is kept in the bladder for an hour or two before being drained away.
You will not be able to eat or drink anything for about six hours before your surgery. This is because you should not have food or drink in your stomach when you are given the anaesthetic. If you do, you are more likely to vomit while you are unconscious, which can lead to complications. The nursing staff will tell you when you will need to stop eating and drinking.
You will come into hospital either the afternoon before or the morning of your surgery and will generally be able to leave within 48 hours.
The clinic will have supplied you in advance with information on what to do beforehand and where to go.
More information on what happens during a TURBT and tips from other people who have had this done, is available in our What is a TURBT? booklet (see link at the bottom of this page).
Take a friend to your appointments if you think it will help and make you feel more comfortable.
2. BCG treatment
BCG treatment is given to patients with high-risk, non-muscle-invasive bladder cancer or CIS.
The treatment involves placing a liquid solution of medication (BCG) directly into your bladder using a catheter. The solution will be kept in your bladder for one or two hours before being drained away. It is an immunotherapy treatment.
BCG stands for Bacillus Calmette-Guerin. The BCG vaccine was originally used to prevent tuberculosis (TB), but it has proved to be a good treatment against bladder cancer. It works by stimulating the immune system to target and destroy any remaining cancer cells. The treatment aims to reduce the risk of the cancer returning.
Advice on how to prepare for the treatment, how it is administered and the after-care will be provided before your first appointment. If you have any concerns, please contact your clinical nurse specialist (CNS).
The advantage of using this type of treatment is that because the medication is placed inside your bladder, rather than being injected into your blood, you are much less likely to experience the side-effects that are most commonly associated with some other treatments, such as nausea, fatigue and hair loss.
Free Care Packages
If you’re having BCG treatment, you can request a free cancer kit if you’re under 65 or a free comfort kit if you’re over 65 from Cancer Support UK.
Before your BCG treatment
When your bladder has healed from your TURBT (this is so the BCG is less likely to enter your bloodstream), you will go into hospital as a day patient for your BCG treatment.
Depending on your urinary symptoms, you may be advised not to drink for two to three hours before your treatment, or sometimes you may be asked for a urine sample before the treatment. The nurse will take a sample to check from the catheter she inserts to instil the BCG. If this sample shows signs of infection, you won’t be treated with BCG until it clears up.
There are often side-effects to be expected following treatment, however, and you will be advised of them before you start.
During treatment
The procedure only takes a few hours.
The liquid drug is fed into your bladder via a catheter, then the catheter is removed.
Most hospitals ask you to stay, and you need to hold the liquid for about two hours before voiding it into a toilet with bleach in it. It can be difficult for some people to hold the liquid for that long, but you must allow the treatment to remain in the bladder as long as possible so it can work effectively.
Since the bladder is like a bag and the aim is to coat the whole lining of the bladder with the solution as thoroughly as possible, you may be advised to walk around, or to lie down and turn over every fifteen minutes or so. You might want to take music, podcasts or audio books to distract you during the two-hour holding period.
BCG explained
Lydia talks to Mr Hugh Mostafid, Consultant Urologist at Royal Surrey County Hospital about how BCG treatments work and common questions patients have.
Please click on CC or watch on YouTube to view the film with subtitles.
In some people BCG treatment can cause uncomfortable and sometimes painful symptoms.
Possible side-effects
BCG treatment is not an easy treatment for everyone. It can be uncomfortable and sometimes painful. Some people are lucky and sail through the treatment, whilst others have quite a difficult time during the process.
It will help if you drink plenty of water, and make sure you look after yourself, eating a good, balanced diet and taking gentle exercise and avoiding stress as much as possible.
IMPORTANT! You must use a condom during sex if either you or your partner is having BCG treatment. Do talk to your CNS to get advice on this.
The common side-effects of BCG treatment include:
- a frequent need to wee
- pain when weeing
- blood in your wee
- joint or back pain
- tiredness
- flu-like symptoms:
- urinary tract infections (raised temperature, cloudy or unpleasant-smelling wee, lower back pain or feeling tired or shaky)
- many men experience a rash in the groin and around the penis
If you experience any of these symptoms and they persist or are troublesome, contact your medical team.
PAIN RELIEF: Pain with BCG treatment is quite common but most people get all the relief they need with over-the-counter painkillers. If these don’t work, talk to your consultant or CNS and they can help you choose other painkillers that might work better for you.
3. In-bladder mitomycin treatment
Mitomycin C is a chemotherapy drug. For non-muscle invasive bladder cancer, it is usually put straight into the bladder via a catheter.
Adults with suspected bladder cancer should be offered a single in-bladder wash of mitomycin C within 24 hours after their first TURBT (transurethral section).
In-bladder mitomycin C treatment involves placing a liquid solution of mitomycin C directly into your bladder using a catheter. The solution will be kept in your bladder for one or two hours before being drained away. It is a chemotherapy treatment.
Some people do four weeks, some people do six weeks, and some people do a whole year of mitomycin C in-bladder chemotherapy.
Using device-assisted therapy with either a heating device or microwave energy seems to increase mitomycin C absorption into the bladder lining and make it more effective.
Mitomycin C works by killing the cancer cells. The treatment aims to reduce the risk of the cancer returning.
Advice on how to prepare for the treatment, how it is administered and the after-care will be provided before your first appointment. If you have any concerns, please contact your clinical nurse specialist (CNS).
After the treatment, you will require another bladder inspection to see if any further treatment will be needed. Whatever the outcome, you will have to go for check-ups for several years to ensure that the cancer does not return.
The advantage of using this type of treatment is that because the medication is placed inside your bladder, rather than being injected into your blood, you are much less likely to experience the side-effects that are most commonly associated with some other treatments, such as nausea, fatigue and hair loss.
Free Care Packages
If you’re having mitomycin treatment, you can request a free cancer kit if you’re under 65 or a free comfort kit if you’re over 65 from Cancer Support UK.
In some people mitomycin treatment can cause uncomfortable and sometimes painful symptoms.
Possible side-effects
Mitomycin treatment is not an easy treatment for everyone. It can be uncomfortable and sometimes painful. Some people are lucky and sail through the treatment, whilst others have quite a difficult time during the process.
It will help if you drink plenty of water, and make sure you look after yourself, eating a good, balanced diet and taking gentle exercise and avoiding stress as much as possible.
IMPORTANT! You must use a condom during sex if either you or your partner is having mitomycin treatment. Do talk to your CNS to get advice on this.
The common side-effects of mitomycin treatment include:
- a frequent need to wee
- pain when weeing
- blood in your wee
- joint or back pain
- tiredness
- flu-like symptoms:
- urinary tract infections (raised temperature, cloudy or unpleasant-smelling wee, lower back pain or feeling tired or shaky)
- many men experience a rash in the groin and around the penis
If you experience any of these symptoms and they persist or are troublesome, contact your medical team.
Support for you
Please remember that you can contact us at any time for support, whether you are a patient or care for someone who is.
Our helpline is open from 09.00–16.30, Monday to Friday. There’s an answerphone if we’re busy, but we will call you back as soon as we can. Call 01844 351 621 or email info@fightbladdercancer.co.uk
Talking to other people who have had the same tests, investigations and diagnosis can help. Our private online forum on Facebook is available 24/7, 365 days a year. (See our getting support page for details of how to join and other support available)
If you would like to receive a friendly card or letter in the mail, with no reply needed, you can request one from From Me to You Letters.
More information
Download copies of our relevant Patient Information Booklets below. If you would like a free copy sent to you by post or email, add your details to our booklets order form and we’ll get them to you.
