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Bladder Cancer Health Center

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Bladder Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage 0 Bladder Cancer Treatment

Standard Treatment Options for Stage 0 Bladder Cancer

Patients with stage 0 bladder tumors can be cured by a variety of treatments, even though the tendency for new tumor formation is high. In a series of patients with Ta or T1 tumors who were followed for a minimum of 20 years or until death, the risk of bladder cancer recurrence after initial resection was 80%.[1] Of greater concern than recurrence is the risk of progression to muscle-invasive, locally-advanced, or metastatic bladder cancer. While progression is rare for patients with low-grade tumors, it is common among patients with high-grade cancers.

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Understanding Bladder Cancer -- Symptoms

In its early stages, bladder cancer may not have obvious symptoms. In the later stages, symptoms of bladder cancer may include: Bloody urine, most often painless, is the most common symptom. The urine color ranges from faintly rusty to deep red, sometimes containing blood clots. Blood traces, invisible to the naked eye, may show up in tests of urine samples. Frequent urinary tract infections, painful urination, a need to urinate often, and difficulty holding in urine. Weight loss...

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One series of 125 patients with TaG3 cancers followed for 15 to 20 years reported that 39% progressed to more advanced-stage disease while 26% died of urothelial cancer. In comparison, among 23 patients with TaG1 tumors, none died and only 5% progressed.[2] Risk factors for recurrence and progression are the following:[2,3,4,5,6]

  • High-grade disease.
  • Presence of carcinomain situ.
  • Tumor larger than 3 cm.
  • Multiple tumors.
  • History of prior bladder cancer.

Standard treatment options for stage 0 bladder cancer include the following:

  1. Transurethral resection (TUR) with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy.
  2. TUR with fulguration.
  3. TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of bacillus Calmette-Guérin (BCG).
  4. TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by intravesical chemotherapy.
  5. Segmental cystectomy (rarely indicated).
  6. Radical cystectomy (in rare, highly selected patients with extensive or refractory superficial high-grade tumors).

Transurethral resection (TUR) with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy

TUR and fulguration are the most common and conservative forms of management. Careful surveillance of subsequent bladder tumor progression is important. Because most bladder cancers recur after TUR, one immediate intravesical instillation of chemotherapy after TUR is often administered. Numerous randomized controlled trials have evaluated this practice, and a meta-analysis of seven trials reported that a single intravesical treatment with chemotherapy reduced the odds of recurrence by 39% (odds ratio, [OR] 0.61; P < .0001).[7,8] However, although a single instillation of chemotherapy lowers the relapse rate in patients with multiple tumors, the majority still relapse. Such treatment is thus not sufficient by itself for these patients.

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