What is stage 0 bladder cancer
Stage 0 bladder cancer consists of both non-invasive papillary carcinoma and flat non-invasive carcinoma. In both cases, the cancer is present in the inner lining of the bladder and has not invaded the bladder wall.
Treatment for stage 0 bladder cancer
This early stage of bladder cancer is commonly treated with transurethral resection (TURBT) with fulguration followed by intravesical therapy within 24 hours.
A TURBT is a procedure in which bladder tumors are removed from the bladder wall. It is performed with a scope that is inserted through the urethra into the bladder. It is usually performed in a day care hospital setting with the patient under anesthesia.
Sometimes no further treatment is needed. Cystoscopy is then done quarterly or biannually to look out for signs of cancer recurrence. Cystoscopy is a procedure that examines inside the bladder using a thin camera called a cystoscope. This device is inserted into the urethra and is passed into the bladder allowing the healthcare professional to inspect the area.
Low-grade tumors are slow-growing. They are also called stage 0a bladder cancer. For these non-invasive papillary tumors, weekly chemotherapy is administered intravesically a few weeks after surgery. If the patient has a relapse of cancer, the treatment is repeated. It is also prescribed for a period of 5 years to prevent a recurrence of the cancer.
High-grade tumors like non-invasive papillary tumors are rapidly spreading. Also known as stage 0is, they are likely to come back after treatment, so intravesical Bacillus-Calmette Guerin (BCG) is done after surgery. Bacillus Calmette–Guérin vaccine is a vaccine that is used against tuberculosis.
Before it is given, TURBT is repeated to be sure the cancer has not affected the muscle layer. BCG is given a regularly for a few weeks after surgery.
Intravesical BCG has proved better than intravesical chemotherapy for high-grade cancers. It prevents cancers from coming back or getting worse. But it also tends to have more side effects. It, too, may be be done for the next year or so.
Stage 0 bladder cancers rarely needs extensive surgery. Partial or complete cystectomy (which is the removal of the bladder) is considered only when there are many superficial cancers or when cancer continues to grow (or metastasize) despite treatment.
Flat non-invasive tumors are treated with BCG after TURBT. Patients with these tumors often get 6 weekly treatments of intravesical BCG, starting a few weeks after TURBT. Doctors may also suggest repeating BCG treatment every 3 to 6 months.
Follow-up and outlook after treatment
After treatment of any stage 0 cancer, close follow-up is needed in combination with cystoscopy for about every 3 months for 2 years to look for signs of cancer recurrence.
The outlook for people with stage non-invasive papillary bladder cancer is very good. These cancers can be cured with treatment. During long-term follow-up care, more superficial cancers are often found in the bladder or in other parts of the urinary system. Although these new cancers do need to be treated, they rarely are deeply invasive or life threatening.
The long-term outlook for stage 0 flat non-invasive bladder cancer is not as good as for stage 0 cancers. These cancers have a higher risk of coming back, and may return as a more serious cancer that’s growing into deeper layers of the bladder or has spread to other tissues.