King Charles: How bladder cancer is treated

We don't know yet what the "other cancer" King Charles has been diagnosed with is, but the most likely explanation is bladder cancer.

Thankfully, Rishi Sunak confirmed reports from Buckingham Palace this week that this was caught at an early stage. The Benign Prostatic Hyperplasia (BPH) that saw King Charles in hospital and this new cancer are completely independent conditions although both can cause waterworks symptoms which could affect Royal duties - especially it they involve standing around for long periods in the cold.

Early bladder cancer is usually removed by the urological surgeon via a cystoscope inserted into the bladder under a general anaesthetic. At that stage the surgeon may not be 100 per cent sure it's a cancer but if there's a strong suspicion a blue chemotherapy drug called Mitomycin C will be instilled into the bladder at the end of the procedure.

The removed specimen is then sent to the pathology department for histological scrutiny.

The cancer is then confirmed the pathologist and he or she will also be able to tell how aggressive it is (The grade) and whether it's grown through the muscle in the bladder wall (The stage). This later issue is very important as it will determine whether is it early or not.

The King's tumour was early so, if indeed a bladder cancer, it should not have grown through the muscle so does not need more serious treatments such as cystectomy (removal of the bladder) or radiotherapy which is required for more advanced cancers.

Usually, a course of local treatments are recommended every week for six weeks after the initial operation. These have been shown to significantly reduce the chance of the cancer coming back in the future. These weekly treatments involve instilling either further Mitomycin C or a TB vaccine called BCG into the bladder via a small catheter. This is called intravesical treatments and fortunately they are both usually very successful as the chance of it coming back in the future is very small.

The choice of whether mitomycin or BCG is used depends on whether the early tumour is low grade (less aggressive) or high grade (more aggressive). Mitomycin works better for low grade and BCG for higher grade.

These procedures are given as an outpatient so don't require an overnight stay. Most often, they are carried out by a highly trained urology nurse. It involves the insertion of a small catheter into the bladder with lubrication without anaesthetic. Once the mitomycin or BCG is instilled into the bladder the catheter is removed. The patient is encouraged to talk around and not pass water for an hour after mitomycin or 2 hours in the case of BCG.

Afterwards, to reduce the inevitable cystitis symptoms the patients are encouraged to drink up to 2 litres of water to dilute the urine. After the six weeks the symptoms should settle gradually. Thereafter, the urologists will perform regular checks via a flexible cystoscope to make sure it does not replace which usually does not involve a general anaesthetic.

The King being fit, a non-smoker and having a good diet will all help to speed up recovery and improve the prognosis further.