Treatment of Bladder Cancer by Stage

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Treatment of Bladder Cancer, by Stage
Most of the time, treatment of bladder cancer is based on the tumor’s clinical stage when it's first diagnosed. This includes how deep it's thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing (grade), and a person’s overall health and preferences, also affect treatment options.

Treating stage 0 bladder cancer
Stage 0 bladder cancer includes non-invasive papillary carcinoma (Ta) and flat non-invasive carcinoma (Tis or carcinoma in situ). In either case, the cancer is only in the inner lining layer of the bladder. It has not invaded (spread deeper into) the bladder wall.

This early stage of bladder cancer is most often treated with transurethral resection (TURBT) with fulguration followed by intravesical therapy within 24 hours.

Stage 0a
Sometimes no further treatment is needed. Cystoscopy is then done every 3 to 6 months to watch for signs that the cancer has come back.

For low-grade (slow-growing) non-invasive papillary (Ta) tumors, weekly intravesical chemotherapy may be started a few weeks after surgery. If the cancer comes back, the treatments can be repeated. Sometimes intravesical chemo is repeated over the next year to try to keep the cancer from coming back.

High-grade (fast-growing) non-invasive papillary (Ta) tumors are more likely to come back after treatment, so intravesical BCG is often used after surgery. Before it's given, TURBT is commonly repeated to be sure the cancer has not affected the muscle layer. BCG is usually started a few weeks after surgery and is given every week for several weeks. Intravesical BCG seems to be better than intravesical chemotherapy for high-grade cancers. It can help both keep these cancers from coming back and keep them from getting worse. But it also tends to have more side effects. It, too, may be done for the next year or so.

Stage 0 bladder cancers rarely need to be treated with more extensive surgery. Partial or complete cystectomy (removal of the bladder) is considered only when there are many superficial cancers or when cancer continues to grow (or seems to be spreading) despite treatment.

Stage 0is
For flat non-invasive (Tis) tumors, intravesical BCG is the treatment of choice after TURBT. Patients with these tumors often get 6 weekly treatments of BCG, starting a few weeks after TURBT. Some doctors recommend repeating BCG treatment every 3 to 6 months.

Follow-up and outlook after treatment
After treatment for any stage 0 cancer, close follow-up is needed, with cystoscopy about every 3 months for a least a couple of years to look for signs of the cancer coming back or new bladder tumors.

The outlook for people with stage 0a (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 0is (flat non-invasive) bladder cancer is not as good as for stage 0a 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.

Treating stage I bladder cancer
Stage I bladder cancers have grown into the connective tissue layer of the bladder wall (T1), but have not reached the muscle layer.

Transurethral resection (TURBT) with fulguration is usually the first treatment for these cancers. But it's done to help determine the extent of the cancer rather than to try to cure it. If no other treatment is given, many people will later get a new bladder cancer, which often will be more advanced. This is more likely to happen if the first cancer is high-grade (fast-growing).

Even if the cancer is found to be low grade (slow-growing), a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG (preferred) or intravesical chemo is usually given. (Less often, close follow-up alone might be an option.) If all of the cancer wasn't removed, options are intravesical BCG or cystectomy (removal of part or all of the bladder).

If the cancer is high grade, if many tumors are present, or if the tumor is very large when it's first found, radical cystectomy may be recommended.

For people who aren’t healthy enough for a cystectomy, radiation therapy (often along with chemo) might be an option, but the chances for cure are not as good.

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  Bladder Cancer