Bladder cancer is one of the most common cancers affecting the urinary system. Fortunately, when detected early, many patients are diagnosed with Non-Muscle Invasive Bladder Cancer (NMIBC)—a form of cancer that remains confined to the inner lining of the bladder and has not yet invaded the deeper bladder muscles.
In a detailed video, Dr. Rahul Jena, Uro-Onco Surgeon at Bagchi Sri Shankara Cancer Centre, Bhubaneswar, explains the step-by-step treatment journey of NMIBC, focusing on BCG therapy, an internationally approved and widely successful treatment modality.
👉 Watch the full video here:
⭐ What is Non-Muscle Invasive Bladder Cancer (NMIBC)?
NMIBC refers to bladder cancer that is limited to the inner layer (mucosa or submucosa) of the bladder wall. It has not spread to the muscle layer, which means it is less aggressive and more treatable compared to muscle-invasive bladder cancer.
Types of NMIBC include:
Ta tumours – confined to the inner lining
T1 tumours – invading the layer below the lining
Carcinoma in situ (CIS) – flat, high-grade, aggressive cancer that spreads across the lining
Because NMIBC has a high risk of recurrence, timely treatment and structured follow-up are critical.
⭐ How is NMIBC Diagnosed?
Dr. Rahul Jena highlights the primary diagnostic tools used:
1. Cystoscopy
A thin, lighted scope is passed into the bladder to directly visualize tumours.
2. Transurethral Resection of Bladder Tumour (TURBT)
A minimally invasive surgery used to remove visible tumours.
This is both a diagnostic and therapeutic procedure.
3. Biopsy & Pathology Report
Determines tumour type, grade, and stage.
4. Urine Cytology / Specialized Tests
Detects high-grade cancer cells in urine.
Diagnosis helps classify patients into low, intermediate, or high-risk groups, which guides treatment decisions.
Types of NMIBC include:
Ta tumours – confined to the inner lining
T1 tumours – invading the layer below the lining
Carcinoma in situ (CIS) – flat, high-grade, aggressive cancer that spreads across the lining
Because NMIBC has a high risk of recurrence, timely treatment and structured follow-up are critical.
⭐ Standard Treatment Approach for NMIBC
The first and most important step in treatment is:
1. TURBT Surgery
This procedure removes the tumour from the bladder without any external incisions. It allows the doctor to examine the tumour completely and confirm its depth.
After TURBT, the next step depends on the risk category.
⭐ BCG Therapy: The Gold Standard for NMIBC
One of the most effective treatments for NMIBC, especially high-grade or CIS, is BCG intravesical immunotherapy.
✔ What is BCG Therapy?
BCG (Bacillus Calmette-Guérin) is a special vaccine originally used for tuberculosis. When placed inside the bladder, it stimulates the immune system to attack cancer cells.
✔ How Does BCG Work?
Activates immune cells inside the bladder
Targets and destroys remaining cancer cells after TURBT
Prevents recurrence
Reduces the risk of progression to muscle-invasive cancer
✔ Who Needs BCG Therapy?
High-grade Ta
T1 tumours
Carcinoma in situ
Recurrent NMIBC
Patients with high-risk features in pathology
As Dr. Rahul Jena emphasizes, BCG is the most effective non-surgical treatment for NMIBC globally.
⭐ BCG Treatment Schedule: What Patients Can Expect
1. Induction Phase
BCG is given once a week for 6 weeks
Helps clear residual cancer cells
2. Maintenance Phase
(Recommended internationally for maximum protection)
Given in cycles over 1–3 years
Usually 3 doses at a time
Helps prevent recurrence in high-risk cancers
Procedure Timeline:
BCG is inserted into the bladder using a catheter
Patient holds it for 1.5–2 hours
Allowed to urinate afterward
Mild burning or frequency may occur
These symptoms are normal and temporary.
⭐ Effectiveness of BCG Therapy
BCG significantly reduces:
✔ Cancer recurrence
✔ Cancer progression
✔ Need for aggressive surgery
✔ Long-term complications
It has been the gold standard for NMIBC for more than 40 years.
⭐ Follow-Up After Treatment
Because NMIBC has a high chance of returning, strict follow-up is essential.
Patients require:
Cystoscopy every 3 months for the first 2 years
Every 6 months from year 3–5
Yearly follow-ups after 5 years
Follow-up ensures early detection if cancer returns.
⭐ What Happens If BCG Does Not Work?
In rare cases where the cancer does not respond to BCG, or if it returns aggressively, doctors may recommend:
✔ Radical Cystectomy
Removal of the bladder to prevent life-threatening spread.
✔ Newer Immunotherapies
Checkpoint inhibitors (Pembrolizumab, Nivolumab) for patients who can’t undergo surgery.
✔ Clinical Trials
Promising for resistant NMIBC.
Dr. Rahul Jena ensures that treatment is personalized for each patient depending on age, tumour biology, and overall health.
⭐ About Dr. Rahul Jena
Dr. Rahul Jena is a Consultant Uro-Oncologist at Bagchi Sri Shankara Cancer Centre, Bhubaneswar, specializing in:
Bladder Cancer
Kidney Cancer
Prostate Cancer
Robotic & Minimally Invasive Cancer Surgery
He is committed to providing world-class cancer care in Eastern India with compassion, precision, and cutting-edge surgical techniques.
📍 Bagchi Sri Shankara Cancer Centre & Research Institute, Bhubaneswar
Plot No. M.I.G-107, Baramunda HB Colony, Bhubaneswar
📞 For Appointments: +91 9938534048
🌐 www.rahuljenaurology.com
⭐ Conclusion
Non-Muscle Invasive Bladder Cancer is highly treatable when diagnosed early.
With modern treatments like TURBT and BCG therapy, many patients achieve excellent long-term control of the disease.
Dr. Rahul Jena’s expertise helps patients understand the journey clearly—from diagnosis to treatment and follow-up.
Early evaluation, timely therapy, and disciplined follow-up can make a life-saving difference.