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
Common treatment for early stage of bladder cancer is transurethral resection (TURBT) with fulguration. The patients receives intravesical therapy within 24 hours after TURBT.
A TURBT is a procedure in which bladder tumors are removed from the bladder wall. There is an insertion of a scope through the urethra into the bladder. The patient is usually under anaesthesia in a daycare setting when a TURBT happens.
Sometimes there is no need for further treatment. Oncologists recommend a cystoscopy every 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 enters into the urethra and into the bladder allowing the healthcare professional to inspect the area.
Low-grade tumors are slow-growing (stage 0a bladder cancer). For these non-invasive papillary tumors, weekly intravesical chemotherapy a few weeks after surgery is an option. If the patient has a relapse of cancer, the treatment repeats. 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 in stage 0, they are likely to come back after treatment. This is why intravesical Bacillus-Calmette Guerin (BCG) follows surgery. Bacillus Calmette–Guérin vaccine is a vaccine that counters tuberculosis.
Before the vaccination, there is another round of TURBT to ensure the cancer does not affect the muscle layer. BCG is is given routinely for a few weeks after surgery.
Intravesical BCG is provenly better than intravesical chemotherapy for high-grade cancers. It prevents cancers from coming back or getting worse. However, it also tends to have more side effects. It, too, may continue 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) occurs 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-ups in combination with cystoscopy for about every 3 months for 2 years are a requirement to look for signs of cancer recurrence.
The outlook for people with stage non-invasive papillary bladder cancer is very good. Cure is possible for these cancers. During long-term follow-up care, more superficial cancers may occur in the bladder or in other parts of the urinary system. Although these new cancers do not need treatment, 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 is growing into deeper layers of the bladder or has spread to other tissues.