Stage I bladder cancers have grown into the connective tissue layer of the bladder wall but have not reached the muscle layer.
Transurethral resection (TURBT) is typically the first treatment for these cancers, but it is done to help determine the extent of the cancer rather than to try to cure it. If no other treatment is given, many patients will later get a new bladder cancer, which will often be more advanced. This is more likely to happen if the first cancer is high grade.
Even if the cancer is found to be low grade, a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG or mitomycin is usually given. (Less often, close follow-up alone might be an option.) If not all of the cancer was removed, options include either intravesical BCG or cystectomy (removal of part or all of the bladder).
If the cancer is high grade, if many tumors are present, or if the tumor is very large when it is first found, radical cystectomy may be recommended.
For people who aren’t healthy enough for a cystectomy, radiation therapy (often along with chemo) might be an option for treatment, although the chances for cure might not be as good.