Monday, February 26, 2024

Different Stages Of Bladder Cancer

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Muscle Invasive Bladder Cancer Staging

Bladder Cancer – Overview (types, pathophysiology, diagnosis, treatment)

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.

What Is Cancer Staging

Staging is a way of describing where the cancer is located, if or where it has invaded or spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancers stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

For bladder cancer, the stage is determined based on examining the sample removed during a transurethral resection of bladder tumor and finding out whether the cancer has spread to other parts of the body.

This page provides detailed information about the system used to find the stage of bladder cancer and the stage groups for bladder cancer, such as stage II or stage IV.

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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Stage 0 Bladder Cancer

Stage 0 describes non-muscle-invasive bladder cancer. It is found only on the surface of the inner lining of the bladder. This stage is also known as in situ. Stage 0 bladder cancer is typically treated with transurethral resection , followed by either close follow-up without further treatment or intravesical therapy using bacillus Calmette-Guérin therapy to try to keep the cancer from coming back.

Staging After Bladder Cancer Recurrence

Bladder Cancer Stages, Artwork Photograph by Peter Gardiner

If bladder cancer returns after treatment, developing a disease called recurrent cancer, doctors may run tests again to understand more about the recurrence, including its stage and grade. This process is called restaging, and it helps doctors determine the best course of action to treat a cancer recurrence. The new stage also has a lowercase r in front of it to indicate that its the stage of the recurrence, not necessarily the original cancers stage.

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Smoking Can Affect The Risk Of Bladder Cancer

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer.

Risk factors for bladder cancer include the following:

  • Using tobacco, especially smoking cigarettes.
  • Having a family history of bladder cancer.
  • Having certain changes in the genes that are linked to bladder cancer.
  • Being exposed to paints, dyes, metals, or petroleum products in the workplace.
  • Past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide.
  • Taking Aristolochia fangchi, a Chinese herb.
  • Drinking water from a well that has high levels of arsenic.
  • Drinking water that has been treated with chlorine.
  • Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
  • Using urinarycatheters for a long time.

Older age is a risk factor for most cancers. The chance of getting cancer increases as you get older.

What Do Different Bladder Cancer Stages Mean

The American Joint Committee on Cancer created a method of staging cancer called the TNM system. Itâs used to describe how far the disease has spread. Itâs based on the following three key pieces of information:

  • T — This measures how far the main tumor has grown through the bladder and whether it has spread into nearby tissues.
  • N — These are groups of cells that fight disease. âNâ is used to describe whether cancer has spread into lymph nodes near the bladder.
  • M — Doctors use this to describe whether the disease has spread into organs or lymph nodes that arenât near the bladder.

Your doctor will assign a number or letter after T, N, and M. The higher the number, the more the cancer has spread.

Once they’ve determined your T, N, and M stages, your doctor will use this information to give you an overall cancer stage. These range from 0 to the Roman numeral IV. Hereâs what each stage means:

Stage 0: The cancer has only grown into the center of your bladder. It hasnât spread into the tissues or muscle of your bladder wall itself. It hasnât spread to your lymph nodes or other organs, either.

Stage I: The cancer has grown through the inner lining of your bladder, but not the muscle of your bladder wall. Nor has it spread to your lymph nodes or distant organs.

Stage II: The cancer has grown through the connective tissue in your bladder and into the muscle layer of the bladder.

Stage IV: This may include any of the following:

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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.

Carcinogenesis And Risk Factors

Diagnosing Bladder Cancer 2 – Stages, Grades & Pathology

Increasing age is the most important risk factor for most cancers. Other risk factors for bladder cancer include the following:

  • Use of tobacco, especially cigarettes.
  • Family history of bladder cancer.
  • HRAS mutation .
  • Occupational exposure to chemicals in processed paint, dye, metal, and petroleum products that include:
  • Aluminum production .
  • Aminobiphenyl and its metabolites.
  • Aromatic amines, benzidine and its derivatives.
  • Treatment with cyclophosphamide, ifosfamide, or pelvic radiation for other malignancies.
  • Use of Chinese herbs: aristolochic acid extracted from species of Aristolochia fangchi.
  • Exposure to arsenic.
  • Arsenic in well water.
  • Inorganic arsenic compounds .
  • Exposure to chlorinated aliphatic hydrocarbons and chlorination by-products in treated water.
  • Schistosoma haematobium bladder infections .
  • Neurogenic bladder and associated use of indwelling catheters.
  • There is strong evidence linking exposure to carcinogens to bladder cancer. The most common risk factor for bladder cancer in the United States is cigarette smoking. It is estimated that up to half of all bladder cancers are caused by cigarette smoking and that smoking increases a persons risk of bladder cancer two to four times above baseline risk. Smokers with less functional polymorphisms of N-acetyltransferase-2 have a higher risk of bladder cancer than other smokers, presumably because of their reduced ability to detoxify carcinogens.

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    Location Of Bladder Cancer Tumors

    The bladder wall is made up of several layers. From innermost to outermost these are:

  • The urothelium lining
  • The connective tissue underlying the urothelium
  • The muscle layer and
  • The fatty tissue surrounding the bladder within the pelvis.
  • Non-muscle invasive bladder cancer refers to tumors within the bladder wall that do not extend into the muscle layer. They may be in the urothelium only or may have spread into the connective tissue that underlies it.

    • Non-muscle invasive cancers that have not spread beyond the urothelium are sometimes referred to as superficial tumors. The two main types are:
      • Non-invasive papillary carcinoma : small, finger-like growths that project from the lining of the bladder towards the hollow center. Over time these tumors can grow into the bladder wall and spread to other parts of the body.
      • Non-invasive carcinoma in situ : a flat tumor that may appear as a red, velvet-like area on the bladder lining. This type of tumor has a high likelihood of progressing to invasive bladder cancer.
    • Non-muscle invasive cancers that have spread into the connective tissue underlying the urothelium but have not penetrated the muscle layer are referred to as category T1 tumors.

    Muscle invasive bladder cancer refers to tumors that have spread into or through the muscle layer of the bladder wall. Depending on the extent of their spread these tumors are assigned to one of the following categories:

    Whats Usually The First Symptom Of Bladder Cancer

    Blood in your pee is the most common bladder cancer symptom. That said, simply having blood in your pee isnt a sure sign of bladder cancer. Other conditions cause this issue, too. But you should contact a healthcare provider whenever you spot blood in your pee. Other bladder cancer symptoms include:

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    Bladder Cancer Staging Grading And Pathology

    Unless you are a medical professional, a bladder cancer pathology report may look like a foreign language to most. But it will answer many questions on what treatment if any you will need going forward. Many people ask for a copy of their pathology report to keep in their treatment folder. What follows is intended, as a basic introduction to the subject, below you will find links to continued reading.

    A doctor will take a sample of tissue they need information about that cannot be seen by the naked eye and sends it to the pathology department.

    The pathologist will look at the tissue and issue a pathology report.

    The pathology report is what guides your bladder cancer treatment.

    It tells your medical treatment team what stage, grade, and type your cancer is.

    Stage and grade are some of the most important things your pathology report will tell you.

    There are several , and each has its own treatment path.

    Stage tells if or how far into the bladder layers cancer has grown.

    Grade tells how different the cancer cells look from normal cells.

    If you have recently been diagnosed with bladder cancer, you may have a lot of many questions. Connect with others just like you on the .

    Why Is The Staging And Grading Of Bladder Cancer Important

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    Accurate staging and grading of bladder cancer is important as it helps to determine a patients most appropriate treatment pathway and provides an indication of their prognosis.For example, the treatment for non-muscle invasive tumors is usually different to that for muscle invasive tumors:

    • Non-muscle invasive bladder cancers are usually treated with TURBT surgery to remove the tumor, which may be combined with medicine delivered directly into the bladder .
    • Muscle-invasive bladder cancers may require treatment that uses a combination of surgery, systemic therapy , and radiation therapy.
    • Visit our Bladder Cancer Treatment page for further information regarding treatments for bladder cancer.

    A patients prognosis refers to the predicted outcome of their bladder cancer. Several factors contribute to prognosis, including bladder cancer type, stage and grade, response to treatment, and the individuals characteristics .

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    Patients May Want To Think About Taking Part In A Clinical Trial

    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

    Many of todays standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

    Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

    Stage I Bladder Cancer

    Stage I describes superficial non-muscle-invasive bladder cancer. It is present in the bladders inner lining but hasnt invaded the muscle wall. We usually perform an initial TUR to determine the extent of the cancer as well as the grade. We typically do a second TUR to remove the rest of the tumor followed by intravesical therapy with either BCG or chemotherapy.

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    Bladder Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Bladder

    The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller to store urine made by the kidneys. There are two kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

    There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant :

    • Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells. Transitional cell carcinoma can be low-grade or high-grade:
    • Low-grade transitional cell carcinoma often recurs after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body.
    • High-grade transitional cell carcinoma often recurs after treatment and often spreads into the muscle layer of the bladder, to other parts of the body, and to lymph nodes. Almost all deaths from bladder cancer are due to high-grade disease.

    See the following PDQ summaries for more information:

    How Do I Take Care Of Myself

    Bladder Cancer: What to Know If Youâve Just Been Diagnosed

    About half of all people with bladder cancer have early-stage cancer thats relatively easy to treat. But bladder cancer often comes back . People whove had bladder cancer will need regular checkups after treatment. Being vigilant about follow-up care is one thing you can do to take care of yourself. Here are some other suggestions from the Bladder Cancer Advocacy Network include:

    • Follow a heart-healthy diet: Plan menus that include skinless poultry and fish, low-fat dairy products, nuts and legumes, and a variety of fruits and vegetables.
    • Focus on high-fiber foods: Bladder cancer treatment may cause digestive issues and a fiber-rich diet may help.
    • Get some exercise: Gentle exercise may help manage stress.
    • Connect with others: Bladder cancer often comes back. Its not easy to have a rare disease thats likely to return. Connecting with people who understand what youre going through may help.

    Urinary diversion

    Some people with bladder cancer need surgery that removes their bladder and their bodies natural reservoir for pee. There are three types of urinary diversion surgeries. All three types involve surgically converting part of your intestine to become a passage tube for pee or a reservoir for storing pee.

    Urinary diversion may be a challenging lifestyle change. If youll need urinary diversion surgery, ask your healthcare provider to explain each surgery types advantages and disadvantages. That way, youll know what to expect and how to take care of yourself.

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    Finding Out Your Specific Diagnosis

    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.

    What Are The Different Stages Of Bladder Cancer

    When coming up with a suitable treatment process with a doctor, you begin by staging your disease. Staging bladder cancer is one of the most critical factors considered when making decisions on treatment options. Your health care providers use different diagnostic tests to analyze and evaluate your bladder cancer to determine an optimal treatment plan. If you have been diagnosed with bladder cancer, you should visit a pathologist to confirm whether the staging information you received was accurate and correct.

    Health care professionals can describe bladder cancer by its stages. This is done by comparing cancerous and healthy cells. If your cancer cells closely resemble those of normal cells, the stage of cancer is regarded as less aggressive, or low grade. This means that its chances of metastasis after first treatment are low. If the cancerous cells are unhealthy and disorganized, judging from their appearance, the stage is said to be high grade.

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