• Carcinoma in situ (CIS)
• Superficial invasive TCC
• Muscle Invasive TCC

The primary treatment for superficial TCC is transurethral resection of the bladder (TURB) or a transurethral fulguration. Using a similar instrument as is used for cystoscopy, the urologist locates and visualizes the tumor within the bladder. A small, wire loop that protrudes from the cystoscope and is connected to an electrical source is used to carefully and precisely resect(cut out) the tumor. On occasion the tumor may be so small or superficial that a fulguration or simple burning of the abnormal tissue will suffice. These are performed while the individual is under regional or general anesthesia and therefore, there is no sensation or memory of the procedure.

Side effects are often related to the depth of the tumor and its location within the bladder. Unless a tumor is obviously superficial, the urologist will very likely need to resect enough bladder wall so that the deeper muscle tissue is sampled. By including muscle in the resected specimen, the pathologist can definitively determine whether or not the tumor invaded the muscle layer.

Depending on the nature and location of the tumor, it may be necessary to leave a catheter inside the bladder for a period of time, occasionally overnight. Very rarely, the urologist may need to resect through the muscle and into the surrounding fat layer, creating a small perforation. Again, this is most often treated by several days of catheter drainage.

In general, low grade superficial bladder tumors have an excellent prognosis, although further superficial recurrences are common. Despite the need for life-long surveillance, subsequent development of more aggressive disease is rare. However, if pathologic examination of the tumor reveals a high grade tumor, then there is a significantly higher chance that the tumor will recur. Here is where significant controversy exists. Option is to recommend close surveillance following the initial resection, whereby a cystoscopic examination is performed every 3 months for an extended period of time. Others may advise shortly after the initial TURB a course of intravesical therapy, such as BCG or even intravesical chemotherapeutics such as Mitomycin C or Thiotepa. These latter agents work by essentially blocking the cancer cells' ability to replicate. Of course, the highly mutating cells can be resistant to these agents. Finally, some urologists will only prescribe additional intravesical therapies if and when there is a recurrence. In rare cases, a high grade lesion that has only invaded into the lamina propria level(T1 lesion) may be a sufficient indication to perform more aggressive treatment such as cystectomy, or complete surgical removal of the bladder. Any treatment reflects a balance between the ability to survey and detect subsequent recurrences before they grow and metastasize, whereas the risks of aggressive therapy such as removing the bladder avoids any risk of local (bladder) recurrences.