Bladder Cancer Stage 0 with Carcinoma in Situ

Stage 0 bladder cancer with carcinoma in situ is the earliest form of bladder cancer, where cancer cells remain in the inner lining of the bladder and haven’t spread deeper into the bladder wall or to other parts of the body.

Table of contents

• What Is Stage 0 Bladder Cancer?
• Understanding Carcinoma in Situ
• Symptoms
• Cancer Grade
• Treatment Approach
• Risk of Recurrence

What Is Stage 0 Bladder Cancer?

Stage 0 bladder cancer means that cancer cells are found in the tissue lining the inside of the bladder but have not invaded into the bladder wall.^[2] This stage is also called noninvasive bladder cancer because the cancer stays in the innermost layer of the bladder, called the urothelium, and hasn’t reached the muscle layer.^[5]

Stage 0 is divided into two types depending on how the tumor looks. Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths extending into the bladder lumen, the space where urine collects. Stage 0is is called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.^[2]

• Bladder
• Urothelium (inner lining of the bladder)

Understanding Carcinoma in Situ

Carcinoma in situ, often shortened to CIS, is an early form of bladder cancer that begins in the cells that line the innermost layer of the bladder. The term “in situ” means “in its original place,” so the cancer hasn’t spread deeper into the bladder wall or to other parts of the body.^[5]

CIS is classified as non-muscle-invasive bladder cancer because it stays in the lining and hasn’t reached the muscle layer.^[5] Unlike papillary carcinoma, which grows toward the hollow part of the bladder in finger-like projections, CIS is a flat, noninvasive carcinoma. Instead of forming a lump, it spreads like a thin sheet along the surface of the urothelium.^[5]

Between 75 percent and 80 percent of all bladder cancers are non-muscle-invasive. Of people diagnosed with non-muscle-invasive bladder cancer, about 10 percent have CIS bladder cancer.^[5]

Symptoms

The most common symptom of bladder cancer is blood in the urine, called hematuria. Many people have blood in the urine without any other uncomfortable symptoms, especially in those with early-stage bladder cancer.^[5]

Even though carcinoma in situ is an early-stage cancer, it’s common for people with CIS to have additional bothersome and uncomfortable urinary symptoms. These can include painful urination, frequent urination, feeling a sudden urgent need to urinate, and urge incontinence, which is when urine leaks suddenly.^[5]

Cancer Grade

Bladder cancers are given a grade based on how abnormal the cancer cells look under the microscope. Knowing the grade helps your cancer care team understand how your cancer may progress and which treatments might work best.^[5]

CIS is always considered high-grade bladder cancer.^[2] High-grade bladder cancer cells look very abnormal compared to normal bladder cells. CIS is more likely than low-grade papillary carcinoma to lead to invasive bladder cancer.^[16]

Treatment Approach

The first treatment for stage 0 bladder cancer is usually a surgical procedure called transurethral resection (TUR) with fulguration to remove the tumor.^[9] During a TUR, a doctor inserts a thin, lighted tube called a cystoscope into the bladder through the urethra to examine the lining of the bladder. The doctor can remove samples of tissue through this tube or can remove some or all of the cancer in the bladder.^[4]

Because stage 0 bladder cancer often comes back after surgery, most people receive intravesical therapy at the time of their first surgery. This means treatment is delivered directly into the bladder. Options include intravesical chemotherapy with mitomycin or gemcitabine, or intravesical BCG.^[9]

For carcinoma in situ specifically, all patients are initially treated with transurethral resection and biopsy with electrical or laser thermal destruction of all visualized cancer.^[16] Treatment typically includes TUR with fulguration, followed by intravesical BCG therapy. Sometimes, intravesical BCG is continued for up to 3 years to lower the risk of recurrence.^[9] This ongoing treatment after the initial surgery is called maintenance therapy and is recommended to help lower the risk of bladder cancer recurrence.^[9]

If you have multiple tumors or carcinoma in situ, another treatment option is surgery to remove part or all of your bladder, called cystectomy.^[9]

Risk of Recurrence

Despite standard treatment, the majority of patients with superficial bladder cancer experience recurrence of their cancer.^[4] Carcinoma in situ has a higher chance of coming back after treatment or spreading to a more advanced stage compared to other types of stage 0 bladder cancer.^[5]

After treatment, patients typically undergo frequent evaluations at regular intervals to detect recurrent or new cancers before they become invasive. This is called surveillance. Routine surveillance tests include urinary cytology, which looks for new cancer cells in the urine, and direct visualization of the lining of the bladder using cystoscopy, typically performed every 3 months.^[4] Regular cystoscopies and possibly additional imaging tests are used to monitor for signs of cancer recurrence or progression.^[9]