Surgery is often part of the treatment plan for bladder cancer, but it may not be necessary for everyone. If you’ve been diagnosed with low-grade bladder cancer, surgery might not be needed, since this type of cancer is usually less aggressive.

In this article, we’ll review surgery and treatment options for people with low-grade bladder cancer tumors.

What Is Low-Grade Bladder Cancer?

The grade of the cancer refers to how normal or abnormal cancer cells look under a microscope. To determine the grade, your urologist will take a small sample of tissue from your bladder (called a biopsy) to study under the microscope.

The cancer grade helps your cancer care team understand how fast your cancer may grow and spread. In general, the more normal the tumor cells look, the less aggressive the cancer tends to be.

“Low-grade bladder cancer” refers to tumors that look similar to healthy bladder cells under a microscope. These cells are also usually organized and grouped in a similar way to healthy bladder tissue. Low-grade cancers that haven’t spread to the muscle layer of the bladder (called non-muscle-invasive bladder cancer, or NMIBC) are usually slow-growing and rarely spread to other parts of the body (metastatic bladder cancer).

On the other hand, high-grade tumor cells appear abnormal and disorganized under a microscope. High-grade bladder cancer is usually more aggressive and has a worse prognosis (outcome) than low-grade tumors because it’s more likely to spread.

Your cancer grade is one factor your cancer care team will use to help choose the best treatment options and estimate your prognosis. It’s important to know that the tumor grade isn’t the same as the cancer stage. The cancer stage describes the tumor’s size and how far the cancer has spread.

What Type of Surgery Is Used To Treat Low-Grade Bladder Cancer?

There are two main types of surgery used to treat low-grade bladder cancer — transurethral resection of bladder tumor (TURBT) and cystectomy. In a TURBT, the tumor is removed, but your bladder stays in your body, and no cuts are made to your skin. In a cystectomy, your bladder, along with the bladder tumor, is removed.

Transurethral Resection of Bladder Tumor

In a TURBT, a long, thin tube with a camera is inserted into your bladder through your urethra. An electrified wire loop on the end of the tube can be used to cut out the tumor and surrounding healthy tissue (called safe margins of resection). This procedure is called fulguration. This tissue can be sent to a laboratory for further testing to help with staging your cancer.

After the procedure, you’ll receive a single dose of chemotherapy directly into your bladder (called intravesical chemotherapy) within 24 hours. This treatment helps kill any remaining cancer cells. Studies show that this single dose of chemotherapy is effective in preventing low-grade bladder tumors from returning.

TURBT for Low-Grade Bladder Cancer

Low-grade NMIBC is often treated with a TURBT. In many cases, this treatment can cure low-grade NMIBC. If you have just one small, low-grade tumor (classified as low-risk NMIBC), a TURBT may be the only treatment you need.

Additional Treatments After TURBT

If you have a low-grade tumor with features that suggest it’s at an intermediate or high risk of returning after treatment (recurring), you may need further treatments. Concerning features may include:

• Large tumor size
• A tumor that has come back after previous treatment
• A tumor growing into the connective layer of tissue
• Carcinoma in situ (a tumor that’s growing flat)

To prevent intermediate or high-risk NMIBC from returning, you may receive intravesical therapy with an immunotherapy drug called Bacillus Calmette-Guérin (BCG) or chemotherapy for a few weeks to a few years. You may also need a second TURBT a few weeks after the first to check for signs that the cancer has come back or spread.

Recovery

Most people will recover from a TURBT within two to four weeks.

A TURBT is usually performed in an operating room under general anesthesia (medicine to put you to sleep so you don’t feel pain). This procedure is not considered major surgery. Some people may even be able to go home the same day, while others may need just a few days to recover in the hospital.

For people with low-grade bladder cancer, a TURBT might be done in their urologist’s office under local anesthesia (numbing only the area where the surgery is performed).

Cystectomy

A cystectomy is the medical term for bladder removal surgery. If only part of the bladder is removed, it’s called a partial cystectomy. If the entire bladder is removed, it’s called a radical cystectomy. During a radical cystectomy, your surgeon will also remove nearby lymph nodes and reproductive organs (including the prostate and seminal vesicles or the ovaries, fallopian tubes, and uterus). A radical cystectomy also requires a urinary diversion procedure to create a new way for urine to exit your body.

The type of cystectomy you need depends on the size and number of tumors in your bladder, as well as your overall health.

Cystectomy for Low-Grade Bladder Cancer

You may need a cystectomy if your low-grade bladder tumor is at a high risk of returning or if other treatments, such as intravesical BCG, don’t work. You may also need a cystectomy with low-grade bladder cancer if your tumor is:

• Very large
• In several locations

• Difficult to reach with TURBT

Health experts typically don’t recommend a radical cystectomy for low-grade bladder cancer until other treatments have been tried.

Recovery

A cystectomy is a major surgery, and most people need several days to recover in the hospital. Full recovery can take a few weeks or even months. If you have a urinary diversion (such as a cystostomy), you’ll also need time to learn how to adjust to a new way of going to the bathroom. This process can take a few months. Talk to your cancer care team to learn more about the recovery process for your surgery and what to expect.

Follow-Up Care After Low-Grade Bladder Cancer Surgery

No matter which type of surgery you have for low-grade bladder cancer, you’ll need close follow-up for several years. Your cancer care team may recommend several different tests to check for signs of recurrent bladder cancer. Some of these tests may include:

• Blood tests — To monitor how well your liver and kidneys are working
• Urine cytology — To check for cancer cells in your urine

• Imaging tests — To check for tumors in your bladder or other parts of your body

If you have a TURBT, it’s recommended to have a cystoscopy (a procedure that uses a long, thin tube with a camera and a light to look inside your bladder) every three months for a few years. Because of the risk of recurrence, close follow-up is important even if your cancer is cured with a TURBT. However, if low-grade bladder cancer does come back, it usually isn’t life-threatening.

Talk to your cancer care team for more information about how often you should have follow-up visits after your bladder cancer treatment.

Are There Alternatives to Surgery for Low-Grade Bladder Cancer?

Most people will need a TURBT at some point in their diagnosis or treatment of low-grade bladder cancer. However, your oncology team may recommend other treatment options for low-grade bladder cancer, including:

• Radiation therapy
• Chemotherapy
• Chemoradiation (a combination of chemotherapy and radiation therapy)
• Immunotherapy

Talk to your cancer care team about the risks and benefits of each treatment option to find the best choice for you.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you or a loved one been diagnosed with low-grade bladder cancer? What type of surgery did you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.