Treatments for stage 0 bladder cancer
The following are treatment options for stage 0 bladder cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Surgery is the main treatment for stage 0 bladder cancer. If most or all of the bladder isn’t removed, surgery is followed by intravesical immunotherapy or chemotherapy. The following types of surgery can be used:
Transurethral resection (TUR) uses a special instrument passed through a cystoscope to remove the tumour along with a margin of normal tissue around it. The surgeon then burns the area from where the tumour was removed with a high-energy electric current (called fulguration) or a laser. This procedure seals off blood vessels and destroys any remaining cancer. A TUR is usually the only treatment needed for small, low-grade stage 0a tumours.
Partial, or segmental, cystectomy removes the tumour and part of the bladder. It may be an option if the bladder tumour can be easily removed with clear surgical margins (no cancer cells in the margins of the tissue removed along with the tumour). This surgery is not very common because bladder cancer is usually in more than one area of the lining of the bladder so it can’t be removed by removing one part of the bladder.
Radical cystectomy removes all of the bladder along with surrounding fatty tissue and nearby lymph nodes. Some reproductive organs may also be removed. In men, the prostate may be removed. In women, the ovaries, the uterus or part of the vagina may be removed. A radical cystectomy is used to treat high-grade Ta and Tis that doesn’t respond to immunotherapy with bacillus Calmette-Guérin (BCG) because these tumours have a high risk of growing into the muscle layer of the bladder wall. After removing the bladder, the surgeon creates a new passage for the urine (called a urinary diversion).
Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells. Biological therapy uses natural or artificial substances that act like (mimic) or block natural cell responses to kill, control or change the behaviour of cancer cells.
This is a type of immunotherapy that is given after a TUR as a primary treatment for stage 0 bladder cancer. Bacillus Calmette-Guérin (BCG) is the most common immunotherapy used to treat bladder cancer. A catheter, or tube, is passed through the urethra and into the bladder so that BCG is given directly into the bladder (called intravesical immunotherapy). BCG may be given for:
- stage 0a tumours that are high grade, large, have come back (recurred) or occur in more than one area (multifocal)
- stage 0is tumours (non-invasive flat urothelial carcinoma, also called carcinoma in situ)
You may be offered chemotherapy instead of BCG after a TUR to treat low-grade, non-invasive tumours. Chemotherapy is used instead of BCG if you are not well enough to cope with the side effects of BCG. It may also be used to treat tumours that come back, or recur, and don’t respond to BCG.
Chemotherapy is usually given directly into the bladder through a urinary catheter, or tube (called intravesical chemotherapy).
The most common chemotherapy drugs used for stage 0 bladder cancer are:
- thiotepa (ThioTEPA)
- mitomycin (Mutamycin)
- doxorubicin (Adriamycin)
- gemcitabine (Gemzar)
You may be asked if you want to join a clinical trial for bladder cancer. Find out more about clinical trials.