Monday, January 30, 2023

Bladder Cancer Stages And Grades

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Stages Types And Grades Of Bladder Cancer

Grading/Staging of Bladder Cancer

The tests and scans you have to diagnose bladder cancer give information about:

  • the type of cell the cancer started in and where it began
  • how abnormal the cells look under the microscope
  • the size of the cancer and whether it has spread

In the UK, doctors use the TNM system and number system to stage bladder cancer. Another way doctors may describe your cancer is:

  • early bladder cancer – the cancer is only in the lining or the connective tissue beneath the bladder lining
  • invasive bladder cancer – the cancer has grown into a deeper layer of the bladder, or beyond

Bladder Reconstructions And Stomas

If you have had your bladder removed, the way you pass urine will change. There are several options that your treatment team will talk to you about:

  • Urostomy is where doctors create a new hole in your abdomen called a stoma. Urine drains from the stoma to the outside of your abdomen into a special bag.
  • Neobladder is where a new bladder made from your small bowel forms a pouch inside your body to store urine. You will pass urine by squeezing your abdominal muscles. You will also pass a small tube into the neobladder each day to help drain the urine.
  • Continent urinary diversion is a pouch made from your small bowel inside your body to store urine. The urine empties through a hole called a stoma to the outside of your abdomen into a special bag.

A bladder reconstruction is a big change in your life. You can speak with a continence or stomal therapy nurse for help, support and information. You can also call Cancer Council . You may be able to speak with a trained Cancer Council volunteer who has had cancer for tips and support.

If you find it difficult to adjust after your bladder reconstruction, it may help to be referred to a psychologist or counsellor.

Note: If you have a stoma, you can join a stoma association for support and free supplies. For more information about stoma associations, visit the Australian Council of Stoma Associations.

The Tnm System Of Bladder Cancer Staging

The size of the tumor and whether it has spread are used to ascertain the stage. Cancer staging specifics are determined by guidelines set by the American Joint Committee on Cancers system, named the TNM staging system.

The TNM system has three parts:

  • T stands for tumor. This number indicates how large the tumor is and how much it has grown into nearby tissues.
  • N stands for nodes. This number indicates if the tumor has spread to lymph nodes, where the lymph nodes are located, and how many lymph nodes are impacted.
  • M stands for metastasis. This number indicates if the tumor has spread to other organs.

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The Stages Of Muscle Invasive Bladder Cancer

Your doctor looks at how far cancer tumours have grown into the bladder. This is called the T stage . There are three T stages of muscle invasive bladder cancer:

  • T2 means cancer has grown into the muscle layer of the bladder
  • T3 means cancer has grown through the muscle layer into the fatty tissue layer

Your doctor also looks at:

  • whether cancer has spread to any lymph nodes
  • whether or not it has spread to other parts of the body like the bones, lungs or liver

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Bladder Cancer Stages, Artwork Photograph by Peter Gardiner

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What Is High Grade Urothelial Carcinoma

What Is High-Grade Urothelial Carcinoma? High-grade urothelial carcinoma is a type of bladder cancer that has a high risk of becoming aggressive and progressing, as stated by the John Hopkins University Department of Pathology. It is more likely to recur in the bladder, invade the muscle wall or spread to other parts of

Stage Ii Bladder Cancer

Stage II cancer has invaded the muscle of the bladder wall but is still confined to the bladder. Depending on the extent and grade of the cancer, we may recommend a partial or total cystectomy. Some people may need chemotherapy before surgery. We may be able to remove the tumor with TUR followed by radiation and chemotherapy.

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Permission To Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks in the following way: .

The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Bladder Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .

Images in this summary are used with permission of the author, artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Finding Out Your Specific Diagnosis

Diagnosing Bladder Cancer 2 – Stages, Grades & Pathology

From the results of the biopsy taken during the TURBT, your consultant will be able to ascertain the type, stage and grade of your cancer. This is what will define whether your cancer is low, intermediate or high risk and determine the type of treatment you will be offered.

Both definitions and treatment options vary considerably, so it is important to take your time to discuss your situation with your doctor and make sure you understand your diagnosis and the treatment you are being offered. Keep asking questions until you understand fully.

If you have ANY queries about your diagnosis or treatment options, ask your team until you are completely sure.

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Cellular Classification Of Bladder Cancer

More than 90% of bladder cancers are transitional cell carcinomas derived from the uroepithelium. About 2% to 7% are squamous cell carcinomas, and 2% are adenocarcinomas. Adenocarcinomas may be of urachal origin or nonurachal origin the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium. Small cell carcinomas also may develop in the bladder. Sarcomas of the bladder are very rare.

Pathologic grade of transitional cell carcinomas, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures, is of great prognostic importance.

References
  • Al-Ahmadie H, Lin O, Reuter VE: Pathology and cytology of tumors of the urinary tract. In: Scardino PT, Linehan WM, Zelefsky MJ, et al., eds.: Comprehensive Textbook of Genitourinary Oncology. 4th ed. Lippincott Williams & Wilkins, 2011, pp 295-316.
  • Koay EJ, Teh BS, Paulino AC, et al.: A Surveillance, Epidemiology, and End Results analysis of small cell carcinoma of the bladder: epidemiology, prognostic variables, and treatment trends. Cancer 117 : 5325-33, 2011.
  • Fahed E, Hansel DE, Raghavan D, et al.: Small cell bladder cancer: biology and management. Semin Oncol 39 : 615-8, 2012.
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    Catheterizable Continent Diversion Pouch

    This is a reservoir of bowel with a stoma that is catheterizable for emptying the bladder. The urine is siphoned out of the urinary reservoir with a small catheter every four to six hours. The catheterizable pouch may require surgical repair at some point after surgery due to the wear and tear of frequent catheterization. This type of reconstruction is not performed on patients with a history of bowel disease.

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    Treatment For Bladder Cancer

    Treatment for bladder cancer depends on how quickly the cancer is growing. Treatment is different for non-muscle invasive bladder cancer and muscle-invasive bladder cancer.

    You might feel confused or unsure about your treatment options and decisions. Its okay to ask your treatment team to explain the information to you more than once. Its often okay to take some time to think about your decisions.

    When deciding on treatment for bladder cancer, you may want to discuss your options with a urologist, radiation oncologist and medical oncologist. Ask your GP for referrals.

    What Causes Bladder Cancer And Am I At Risk

    Stages of bladder cancer stock vector. Illustration of neoplasia

    Each year, about 83,730 new cases of bladder cancer will be diagnosed in the United States. It affects more men than women and the average age at diagnosis is 73.

    Cigarette smoking is the biggest risk factor for bladder cancer. About half of all bladder cancers are caused by cigarette smoking. Other risk factors for developing bladder cancer include: family history, occupational exposure to chemicals , previous cancer treatment with cyclophosphamide, ifosfamide, or pelvic radiation, the medication pioglitazone, exposure to arsenic , aristolochic , bladder infections caused by schistosoma haematobium, not drinking enough fluids, a genetic condition called Lynch Syndrome, a mutation of the retinoblastoma gene or the PTEN gene. and neurogenic bladder and the overuse of indwelling catheters.

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    Other Squamous Cell Carcinoma Risk Factors

    Having bladder diverticula may increase an individuals chance of developing SCC. Rarely, bacillus Calmette-Guerin treatment for CIS has been reported to lead to development of SCC. Development of bladder cancer at a younger age has been associated with bladder exstrophy. SCC has also been described in urachal remnants.

    Coffee consumption does not increase the risk of developing bladder cancer. Early studies of rodents and a minority of human studies suggested a weak connection between artificial sweeteners and bladder cancer however, most recent studies show no significant correlation.

    Evaluation Of Upper Urinary Tract

    Additional workup for all patients with bladder cancer includes evaluation of the upper urinary tract with intravenous urography , renal ultrasonography, computed tomography urography, or magnetic resonance urography.21,22 Renal ultrasonography alone is insufficient to complete the evaluation of hematuria in a patient with bladder cancer because it cannot delineate details of the urinary collecting system. Traditional IVU has been largely replaced by CT urography because of increased detail and data combined in the CT .

    For patients unable to undergo contrast injection , magnetic resonance urography may be used to evaluate the upper urinary tract. These tests are useful for disease staging and excluding other causes of hematuria. Pelvic imaging should be performed before transurethral resection to improve staging accuracy because postoperative inflammation mimics the appearance of tumor infiltration.21 Pelvic imaging also may detect synchronous upper tract urothelial cancer, which can occur in 5 percent of patients with bladder cancer.22

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    How Can I Prevent Bladder Cancer

    You may not be able to prevent bladder cancer, but it may be helpful to know the risk factors that may increase the chance youll develop bladder cancer. Bladder cancer risk factors may include:

    • Smoking cigarettes: Cigarette smoking more than doubles the risk of developing bladder cancer. Smoking pipes and cigars or being exposed to second-hand smoke also increases that risk.
    • Cancer treatments: Radiation therapy is the second-most common risk factor. People who have certain chemotherapy drugs may also develop an increased risk of bladder cancer.
    • Exposure to certain chemicals: People who work with chemicals, such as aromatic amines , are at an increased risk. Extensive exposure to rubber, leather, some textiles, paint and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
    • Infections: People who have frequent bladder infections, bladder stones or other urinary tract diseases may have an increased risk of developing bladder cancer.
    • Past bladder cancer: People with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.

    What Are The Pathological Outcomes Of Second Tur

    Understanding Types and Grades of Non-Muscle Invasive Bladder Cancer

    Pathological outcomes from second TURs in patients with high-grade T1 are associated with prognosis. Herr et al. conducted a study in a cohort of 352 patients with T1 on initial TUR, and compared progression according to pathological outcome on second TUR. Of the 92 patients with residual T1 cancer, 82% progressed to muscle invasion within 5 years compared to 19% of those who had no or non-T1 tumor detected on restaging TUR. Dalbagni et al. performed a retrospective review of pathological outcomes from second TURs in 523 patients with T1 on initial TUR, and suggested that patients with T1 disease on restaging had a higher risk of progression thus early cystectomy should be considered.

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    Start And Spread Of Bladder Cancer

    The wall of the bladder has many several layers. Each layer is made up of different kinds of cells .

    Most bladder cancers start in the innermost lining of the bladder, which is called the urothelium or transitional epithelium. As the cancer grows into or through the other layers in the bladder wall, it has a higher stage, becomes more advanced, and can be harder to treat.

    Over time, the cancer might grow outside the bladder and into nearby structures. It might spread to nearby lymph nodes, or to other parts of the body.

    How Successful Is Bladder Cancer Treatment

    Bladder cancer can usually be treated effectively, especially when tumors are diagnosed at an early stage. Bladder cancers detected at late stages are often more complex to treat and may have an uncertain prognosis. Subsequently, the statistical 5-year relative survival rate is high for bladder cancers that are still within the surface layer of the bladder wall or have not spread beyond the bladder , and progressively lower for cancers that have spread within the pelvis or to distant sites.2 See Bladder Cancer Survival: The Importance of Early Detection for further information related to the factors affecting bladder cancer survival.

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    Muscle Invasive Bladder Cancer Staging

    Muscle invasive bladder cancer has spread into or through the muscle layer of the bladder. To describe some muscle invasive bladder cancer, doctors might also use the terms:

    • locally advanced bladder cancer
    • metastatic or advanced bladder cancer

    Muscle invasive bladder cancer is different to non muscle invasive bladder cancer. In non muscle invasive bladder cancer, the cancer cells are only in the inner lining. They havent spread into the muscle layer of the bladder wall.

    Side Effects Of Treatment For Bladder Cancer

    Bladder Cancer

    All cancer treatments can have side effects. Your treatment team will discuss these with you before you start treatment. Talk to your doctor or nurse about any side effects you are experiencing. Some side effects can be upsetting and difficult, but there is help if you need it.

    or email to speak with a caring cancer nurse for support.

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    How Do Healthcare Providers Diagnose Bladder Cancer

    Healthcare providers do a series of tests to diagnose bladder cancer, including:

    • Urinalysis: Providers use a variety of tests to analyze your pee. In this case, they may do urinalysis to rule out infection.
    • Cytology: Providers examine cells under a microscope for signs of cancer.
    • Cystoscopy: This is the primary test to identify and diagnose bladder cancer. For this test, providers use a pencil-sized lighted tube called a cystoscope to view the inside of your bladder and urethra. They may use a fluorescent dye and a special blue light that makes it easier to see cancer in your bladder. Providers may also take tissue samples while doing cystoscopies.

    If urinalysis, cytology and cystoscopy results show you have bladder cancer, healthcare providers then do tests to learn more about the cancer, including:

    Healthcare providers then use what they learn about the cancer to stage the disease. Staging cancer helps providers plan treatment and develop a potential prognosis or expected outcome.

    Bladder cancer can be either early stage or invasive .

    The stages range from TA to IV . In the earliest stages , the cancer is confined to the lining of your bladder or in the connective tissue just below the lining, but hasnt invaded the main muscle wall of your bladder.

    Stages II to IV denote invasive cancer:

    A more sophisticated and preferred staging system is TNM, which stands for tumor, node involvement and metastases. In this system:

    Staging System Of Bladder Cancer

    Staging determines where the tumor is located, whether it has spread or not, and how it grows. While assessing the Stages of Bladder Cancer, many factors are taken into account, including how it is developing in the bladder, where it is growing and has it spread both inside and outside the bladder. In the case of bladder cancer, the stage is determined based on examining the sample removed during a TURBT and finding out whether the cancer has spread to other parts of the body 1.

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