Non-muscle-invasive bladder cancer
Prepared with OnCo (onco.cc/prep/non-muscle-invasive-bladder-cancer/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
15 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Grade and stage, Carcinoma in situ and lymphovascular invasion, FGFR3 mutations, Urinary biomarkers and cytology for surveillance, Molecular subtypes under study), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (diagnosis and resection), which of the standard options do you recommend and why?
- 6.For my situation (low risk), which of the standard options do you recommend and why?
- 7.Am I a candidate for Mitomycin C, Gemcitabine, and what side effects should I expect?
- 8.For my situation (intermediate and high risk), which of the standard options do you recommend and why?
- 9.For my situation (bcg-unresponsive), which of the standard options do you recommend and why?
- 10.Am I a candidate for Pembrolizumab, Nadofaragene firadenovec, Nogapendekin alfa inbakicept or related drugs, and what side effects should I expect?
- 11.Are there clinical trials I could join, for example of Gemcitabine intravesical system (TAR-200), Cretostimogene grenadenorepvec?
- 12.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 13.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 14.I read that “Recurrent BCG shortages”. How does that affect my plan?
- 15.I read that “Predicting who will progress to muscle invasion”. How does that affect my plan?
The words I may hear
- Radical cystectomy: Removing the bladder (and nearby organs) for bladder cancer that has grown into the muscle wall; urine is then diverted through a stoma or a new bladder made of bowel.
Tests and results to bring
Diagnosis and resection: Cystoscopy, transurethral resection with muscle in the specimen, blue-light or enhanced imaging for carcinoma in situ; re-resection of T1 tumours.
Biomarker results to ask for: Grade and stage (EAU and AUA risk groups), Carcinoma in situ and lymphovascular invasion, FGFR3 mutations (common in low-grade disease), Urinary biomarkers and cytology for surveillance, Molecular subtypes under study.
Scans and tests linked to this cancer: Urine tests for bladder cancer (cytology, FISH, RNA and methylation), Bladder EpiCheck urine methylation test.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Low risk: Single immediate instillation of mitomycin or gemcitabine after resection; surveillance cystoscopy. (Mitomycin C, Gemcitabine)
- Intermediate and high risk: Induction and one to three years of maintenance BCG; intravesical chemotherapy when BCG is unavailable; early cystectomy for the highest-risk T1 disease. (Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy))
- BCG-unresponsive: Radical cystectomy, or bladder-sparing treatment: pembrolizumab, nadofaragene firadenovec, nogapendekin alfa inbakicept with BCG, TAR-200, cretostimogene in trials and early approvals. (Radical cystectomy, Pembrolizumab, Nadofaragene firadenovec, Nogapendekin alfa inbakicept, Gemcitabine intravesical system (TAR-200), Cretostimogene grenadenorepvec)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.