Overview of non-muscle invasive bladder cancer

Dr. Bimal Bhindi, MD, CM, MSc., FRCSC, Urologic Oncologist

Duration: 4 minutes and 11 seconds

Non-Muscle Invasive Bladder Cancer (NMIBC) is a type of bladder cancer that affects the inner lining of the bladder but has not spread to the deeper muscle layer. It’s the most common form of bladder cancer, accounting for about 70-80% of all bladder cancer cases.

NMIBC is often diagnosed after noticing symptoms like blood in the urine (hematuria), frequent urination, or pain during urination. If bladder cancer is suspected, your doctor may recommend tests like: - Cystoscopy: A procedure where a thin camera is inserted through the urethra to view the inside of the bladder. - Urine Cytology: A test to check for cancer cells in the urine. - Biopsy: similar to cystoscopy with the use of the camera, a small sample of tissue may be taken to confirm the diagnosis.

NMIBC is classified into different stages and grades: - Stages (how deep has the cancer gone into the bladder) - Ta: Cancer is confined to the inner lining of the bladder. - T1: Cancer has spread to the connective tissue layer just below the bladder lining but not the muscle. - CIS (Carcinoma in situ): A flat, high-grade tumor that is limited to the bladder lining but is considered aggressive. - Grades: (how aggressive do the cells look under the microscope) - Low-grade: Cancer cells look more like normal cells and tend to grow slowly. - High-grade: Cancer cells look abnormal, grow more quickly, and are more likely to spread.

The treatment for NMIBC depends on the stage, grade, and risk of recurrence or progression. Common treatments include:

- Transurethral Resection of Bladder Tumor (TURBT: A surgical procedure to remove the tumor from the bladder through the urethra. - Intravesical Therapy: Treatment delivered directly into the bladder. This includes: - BCG (Bacillus Calmette-Guerin): An immunotherapy that uses a weakened form of bacteria to stimulate the immune system to attack cancer cells. - Intravesical Chemotherapy: Drugs like mitomycin C are used to kill cancer cells and prevent them from returning.

NMIBC has a high chance of recurrence, so regular follow-up is crucial. This typically includes regular cystoscopies to check for new tumors and urine tests to detect cancer cells. Patients should have regular follow-up with their urology team.

Being diagnosed with NMIBC can be overwhelming, but most cases are treatable and manageable with regular monitoring. It’s important to follow your doctor’s advice on treatment and follow-up care to catch any recurrences early.

It is important to remember that NMIBC is a common form of bladder cancer that hasn’t spread to the bladder muscle and treatment often involves surgery within the bladder and/or intravesical therapy. Regular follow-up is essential due to the high risk of recurrence.

Presenter: Dr. Bimal Bhindi, Oncologist, Calgary, AB

Local Practitioners: Oncologist