Newly Diagnosed With NMIBC: What to Expect

Hearing that you have bladder cancer can feel scary and overwhelming. If you have been diagnosed with non-muscle invasive bladder cancer, called NMIBC, it means the cancer has moved deeper into the bladder but has not spread to the muscle.¹

Here is what you need to know after a diagnosis of NMIBC.

Understanding your NMIBC diagnosis

Non-muscle invasive bladder cancer (NMIBC) means the cancer cells are only in the inner lining of the bladder. They have not grown into the deeper muscle layer of the bladder wall. Think of the bladder wall like a layer cake. NMIBC is only in the frosting or the very top layer, but not in the thicker cake layers underneath.¹

This is different from more advanced bladder cancers, such as muscle-invasive bladder cancer. Muscle-invasive bladder cancer has grown into the muscle layer or even deeper.¹

NMIBC is less likely to spread to other parts of the body than muscle-invasive bladder cancer. Because NMIBC is found early and has not grown deep, it is often easier to treat.¹

Understanding NMIBC staging

After your doctor finds bladder cancer, they will determine the stage. The stage describes how far the cancer has spread.²

For NMIBC, the stage tells us how deeply the cancer has grown into the inner lining. The most common stages for NMIBC are Ta, T1, and CIS. These are the earliest stages of bladder cancer:^1-3

• Stage Ta – The cancer is slow-growing (also known as low-grade) and is only in the innermost layer of the bladder lining. This is the most common stage – 70 percent of people with NMIBC have stage Ta.
• Stage T1 – The cancer has grown through the inner lining to the layer of connective tissue just beneath it. It has not reached the muscle. About 20 percent of people with NMIBC have stage T1.
• Stage CIS (Carcinoma in Situ) – This is a flat, noninvasive lesion on the inner lining of the bladder. This cancer is faster-growing (high-grade) than the others. Around 10 percent of people with NMIBC have stage CIS.

Your doctor will also talk about the grade of the cancer. The grade describes how the cancer cells look under a microscope. Low-grade cells look more like normal cells and tend to grow slowly. High-grade cells look less like normal cells and may grow more quickly. CIS is considered high-grade.²

Treatment options after diagnosis

After an NMIBC diagnosis, your care team will go over the best treatment options for you. There are several ways to treat NMIBC.

Transurethral resection of bladder tumor (TURBT)

A TURBT is typically the first treatment for people with NMIBC. During a TURBT, a doctor uses a thin tube with a camera, called a cystoscope, to look inside your bladder. They will remove the tumor or tumors and any surrounding tissue that has been affected. This tissue is then sent to a lab to confirm the diagnosis, find the stage, and determine the grade.^1-3

Intravesical chemotherapy

Depending on the stage and grade of your cancer, you may need more treatment after the TURBT. Intravesical chemotherapy is used to kill any remaining cancer cells, lowering the chance of the cancer returning. This procedure involves putting chemotherapy drugs directly into your bladder using a catheter. Intravesical chemotherapy kills the cancer without harming the surrounding tissue.^1-3

Radical cystectomy

Sometimes, with high-grade tumors, a radical cystectomy may be needed. This procedure removes the bladder and surrounding organs. This procedure is more common with stage CIS NMIBC.^1-3

Follow-up tests and procedures

Because NMIBC can recur, regular follow-up is very important. Your doctor will create a follow-up schedule for you. How often you need these follow-up tests depends on your stage and risk factors. They can include:^1,3,4

• Regular cystoscopies – This common procedure involves inserting a thin, flexible tube called a cystoscope into your urethra (after numbing the area) and slowly guiding it up into your bladder. The cystoscope has a light and a small camera or lens on the end. This allows your doctor to see if there are any new growths.
• Cytology – A test that looks for any abnormal or cancerous cells in your urine. A urine sample is taken, and the cells are then studied under a microscope.
• Urinalysis – A urine test analyzes your urine to rule out other health issues, like infection.
• Other tests – If the above tests are inconclusive, other tests may be needed, such as computed tomography (CT) scans and magnetic resonance imaging (MRI).

Follow-up visits help your care team find any new cancer early, when it is most treatable. It is important to go to all your follow-up appointments.^3,4

The prognosis of NMIBC

For most people diagnosed with non-muscle invasive bladder cancer, the outlook is very good. Because the cancer is found in the early layers of the bladder lining and has not grown into the muscle, it is highly treatable. Many people with NMIBC can be cured.⁴

However, NMIBC can sometimes come back in the bladder. This is called recurrence. The chance of recurrence varies for each person based on factors like the stage and grade of the cancer. This is why regular follow-up visits with your care team are so important, so they can check for any signs of the cancer returning and treat it early if needed.⁴

Have an open dialogue with your care team

Do not hesitate to ask your doctor and care team questions. Write down your questions before your appointments. Bring a family member or friend with you for support and to help you remember information. Understanding your diagnosis and treatment plan is a key part of managing your health.