If you have stage 1 bladder cancer, surgery is the most common form
of treatment. After surgery, your doctor may use drugs to decrease the
risk of the cancer coming back in your body.

In stage I, cancer invades the subepithelial (below the surface) connective
tissue. Stage 1 cancer is classified as "superficial bladder cancer"
because it does not invade the muscle wall of the bladder and has not
spread to lymph nodes or other organs.

Transurethral resection (TUR) using electrical or laser thermal to destroy
visible cancer is the standard initial treatment for all patients in this
stage. A TUR is an operation that is performed to diagnose and manage
bladder cancer.

During a TUR, a urologist inserts a thin, lighted tube -called a cystoscope
- into the bladder through the urethra to examine the lining of the bladder.
The urologist can remove samples of tissue (a biopsy) through this tube
or can remove some or all of the cancer in the bladder.

Rarely, for more extensive or multiple superficial cancers, a segmental
cystectomy (partial removal of the bladder) is necessary. More rarely,
a surgeon performs a radical cystectomy (complete removal of the bladder)
to treat the cancer. Surgery (TUR) alone is effective in preventing recurrences
in approximately 50 percent of patients with superficial bladder cancer.

Failure of treatment is usually due to the appearance of new superficial
cancers. This cancer also is treatable with TUR. Within 15 or 20 years,
more than half of surviving patients will experience progressive cancer
or more commonly will develop new cancers.

These may include cancers of the upper urinary tract (ureters and renal
pelvis). Approximately 20 percent to 30 percent of these cancers will
require complete removal of the bladder.

Frequent follow-up exams are important to detect new cancer formation.
Early detection is vital because treatment is more effective for small
advanced bladder cancers.
After Surgery Treatment

Because bladder cancer can come back frequently, it is important to develop
strategies to prevent it. Treatment after surgery (adjuvant therapy) provides
further benefits.

The goal of adjuvant therapy is to improve the chances of a cure, prevent
cancer from recurring or progressing to a worse stage, and to prolong
life. Adjuvant therapy for papillary carcinoma and carcinoma in situ typically
consists of chemotherapy and/or biologic therapy following surgery.

Delivery methods for adjuvant therapy differ depending on the needs of
the patient. Although some adjuvant treatments enter the patient’s blood
system through a vein, others go directly into the bladder.
Bacille Calmette-Guérin (BCG)

Bacille Calmette-Guérin (BCG) is one of the most
common adjuvant therapies for treatment of superficial and other bladder
cancers. BCG is a weak form of a bacteria similar to the one that causes
tuberculosis.

BCG enters directly into the bladder through the urethra and tells your
body’s immune system to kill cancer cells. The primary side effects of
BCG are pain in the bladder, blood in urine, and rarely, autoimmune disorders
(where the body’s immune system attacks its own cells). Because BCG is
live bacteria, it may occasionally grow and cause an infection requiring
antibiotic treatment.

Approximately 70 percent of patients with superficial bladder cancer
respond to the periodic insertion of BCG into the bladder. Treatment with
BCG delays progression into the muscle and/or the overall spread of bladder
cancer, reduces damage to the bladder, and decreases the risk of death
from the disease.

· With BCG immunotherapy, 65 percent of patients with the disappearance
of tumors will remain cancer-free for 5 years.

· Using booster doses of BCG every 3 months for up to 2 to 3 years
increases the percentage of patients with no signs of tumors to more than
80 percent. In addition, 80 percent of patients who experience the complete
disappearance of tumors remain disease-free.

BCG also can be injected into the skin, similar to the method for prevention
of tuberculosis; however, most urologists no longer use this method.
Chemotherapy

Placing chemotherapy drugs into the bladder through a needle into your
vein is considered a good second choice for adjuvant therapy. Chemotherapy
is very effective in patients who have a low risk of cancer returning.

Injection of chemotherapy drugs (Mutamycin®, Thioplex®, or doxorubicin)
into the bladder can reduce the possibility of having of superficial cancer
again. However, no single drug has been confirmed to prevent superficial
cancer from becoming invasive (spreading) bladder cancer. This means that
multiple small new cancers can be prevented, but progression to a more
invasive bladder cancer may occur despite treatment.

The optimal time to administer chemotherapy is immediately after TUR
because the drugs might prevent new cancer cells from forming. Among potential
drugs to use, Mutamycin produces few side effects and more of the drug
remains in the bladder than with other treatments. Thioplex is rapidly
absorbed in the body and produces low blood counts. Doxorubicin produces
the most local side effects.