Non Muscle Invasive Bladder Cancer
In non muscle invasive bladder cancers, the cancer is only in the lining of the bladder. It has not grown into the deeper layers of the bladder wall. Non muscle invasive bladder cancer is also called superficial bladder cancer, or early bladder cancer.
Early bladder cancer usually appears as small growths, shaped like mushrooms. These grow out of the bladder lining. This is called papillary bladder cancer. Your surgeon can remove these growths and they may never come back.
But some types of early bladder cancer are more likely to come back. These include carcinoma in situ and high grade T1 tumours. T1 stands for the size of the tumour.
Carcinoma in situ
Unlike other early bladder cancers, areas of CIS are flat. They do not grow out of the bladder wall. In CIS the cancer cells look very abnormal and are likely to grow quickly. This is called high grade. It is more likely to come back than other types of early bladder cancer.
High grade T1 tumours
T1 tumours are early cancers that have grown from the bladder lining into a layer underneath, called the lamina propria. High grade T1 tumours are early cancers, but they can grow very quickly.
Risk groups
Doctors divide early bladder cancer into 3 risk groups. These risk groups describe how likely it is that your cancer will spread further or come back after treatment. Your risk group depends on several factors including the size of the tumour , what the tissue looks like under the microscope and type of bladder tumour.
What Is Upper Tract Urothelial Cancer
Upper tract urothelial cancer is a cancer that occurs in either the inner lining of the tube that connects the kidney to the bladder or within the inner lining of the kidney.
The lining of the bladder, kidney and ureter are the same, so there are some similarities between upper tract urothelial cancer and bladder cancer.
Upper tract urothelial cancer is not common with about 470 Australians diagnosed each year. It is three times more likely to be diagnoses in men than women and is more common in people over the age of 70 years.
Sarcomatoid Carcinoma Of The Urinary Bladder
The sarcomatoid areas may merge with foci of urothelial carcinoma , squamous cell carcinoma, adenocarcinoma or small-cell carcinoma, and most commonly resemble a high-grade sarcoma, not otherwise specified, or have a malignant fibrous histiocytoma histology. Heterologous differentiation may be present but has no definite prognostic significance . In decreasing order of frequency, areas of osteosarcoma, chondrosarcoma, rhabdomyosarcoma, liposarcoma, angiosarcoma or a mixture of sarcoma histologies may be seen. In the absence of an obvious invasive carcinoma , in a primarily malignant spindle cell tumor of the bladder, history of prior urothelial neoplasia, coexistence of in situ disease such as urothelial carcinoma in situ or strong and relatively diffuse cytokeratin immunoreactivity is helpful in making the diagnosis of sarcomatoid carcinoma over a primary sarcoma. Earlier treatment with radiation therapy and intravesical cyclophosphamide chemotherapy has been associated with sarcomatoid carcinoma, as also with external beam radiation for prostate cancer.
Figure 9
Sarcomatoid carcinoma of the urinary bladder. Urothelial carcinoma and high-grade spindle cell morphology of sarcomatoid component. Heterologous cartilaginous differentiation.
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Morphologic Variants Of Urothelial Carcinoma
Some cases of urothelial carcinoma show morphologic patterns that are recognized as variants morphology. Those include nested variant, micropapillary, lymphoepithelioma-like, sarcomatoid, small cell carcinoma, and adenocarcinoma. These are frequently under-recognized in bladder biopsies and could have therapeutic implications with different criteria for surgery and different chemotherapy regimens.
Therapy Of Bc In 2020
The standard of care for the treatment of NMIBC contains transurethral resection of the bladder tumor . In case of low risk disease, an early postoperative chemotherapy instillation of the bladder reduces risk of recurrence. In high risk disease, a confirmation TURBT is suggested, followed by intravesical instillations with BCG . The first-line treatment of CIS is not surgical but performed with BCG instillations with a complete response rate in 7293% patients . One in two patients with initial complete response is likely to show recurrence with the need of further installation therapies or RC .
The standard of care for the treatment of MIBC contains radical cystectomy, pelvic lymph node dissection and urinary diversion .
To improve patient outcomes, perioperative chemotherapy has been investigated. Cisplatin based neoadjuvant chemotherapy, which has been used since 1980s, was studied in several RCTs which demonstrated a statistically relevant survival advantage in patients with MIBC prior to surgery. A recent meta-analysis on patients compared clinical outcomes of MVAC: methotrexate, vinblastine, doxorubicin, and cisplatin vs. GC: gemcitabine and cisplatin/carboplatin in the neoadjuvant setting. Cisplatin-based neoadjuvant chemotherapy showed a 16% reduction in overall death risk, compared with locoregional therapy alone and absolute survival benefit of 8% at 5 years .
Adjuvant immunotherapy is investigated in many clinical trials, but data have not been published yet.
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Transitional Cell Bladder Cancer
When people in the UK talkabout bladder cancer they areusually referring to transitional cell bladder cancer . This type of bladder cancer develops from thecells of the bladder lining – these are called transitionalcells. This is by far the most common formof bladder cancer in the UK accounting for more than 90% of all new bladder cancers diagnosed.
The information on treatment options and prognosisof bladder cancer elsewhere on this website, and indeed in most books or othersources, refers to treatment and prognosis of transitional cell cancer of thebladder. There is information about someof the rarer types of bladder cancer further down this page.
Transitional cell bladder cancers are not all the same.
Where Are The Urothelial Cells Located In The Body
It begins in the urothelial cells, which line the inside of the bladder and other parts of the urinary tract. These cells proliferate and form a tumor. This type of cancer most often occurs in the bladder, but can occur anywhere urothelial cells are present, including the urethra, ureters, and kidneys.
Prognosis and survival rate. The prognosis of urothelial carcinoma depends on the invasive nature of the malignancy and the spread of metastases. In the case of the initial stage, a low-grade cancerous lesion provides a good prognosis, whereas a poor prognosis is reported with the high-grade cancerous lesion.
https://www.youtube.com/watch?v=5l11z9ZzOwU
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What Other Types Of Bladder Cancer Are There
Several less common types of bladder cancer make up the remaining approximately 10% of bladder cancers. Some examples of the uncommon types include:
- Squamous cell carcinoma: Squamous cells develop in the lining of the bladder as a result of irritation or inflammation. These cells may eventually become cancerous. Although squamous cell carcinoma is uncommon, making up around 4% of all bladder cancers,2 it has a high likelihood of progression.
- Adenocarcinoma: This type of bladder cancer consists of glandular-type cells and is usually invasive. Overall, around 2% of bladder cancers are adenocarcinomas.2
- Small cell carcinoma: Small cell carcinomas of the bladder start in nerve-like cells. This bladder cancer type is rare, accounting for less than 1% of bladder cancers,4 but can grow rapidly and spread to other parts of the body.
- Sarcoma: A sarcoma is a type of cancer that begins in the bodys supporting tissues, such as bone, muscle, fibrous tissues, and fat. Very rarely, sarcomas may arise from the muscle or fat layers of the bladder.
Although the treatment for most bladder cancer types is similar for early-stage tumors, different drugs may be used if chemotherapy is undertaken.
Small Cell Carcinoma Of The Bladder
This aggressive form of the disease begins in small nerve-like cells in the bladder called neuroendocrine cells. Small cell carcinoma makes up about 1 percent of bladder cancers. It is often detected at an advanced stage, after it has spread to other parts of the body. It usually requires a combination of treatments, including chemotherapy, surgery, and radiation therapy.
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What Are The Types Of Bladder Cancer Tumors That May Form
Three types of bladder cancer may form, and each type of tumor can be present in one or more areas of the bladder, and more than one type can be present at the same time:
- Papillary tumors stick out from the bladder lining on a stalk. They tend to grow into the bladder cavity, away from the bladder wall, instead of deeper into the layers of the bladder wall.
- Sessile tumors lie flat against the bladder lining. Sessile tumors are much more likely than papillary tumors to grow deeper into the layers of the bladder wall.
- Carcinoma in situ is a cancerous patch of bladder lining, often referred to as a flat tumor. The patch may look almost normal or may look red and inflamed. CIS is a type of nonmuscle-invasive bladder cancer that is of higher grade and increases the risk of recurrence and progression. At diagnosis, approximately 10% of patients with bladder cancer present with CIS.
Urothelial Carcinoma With Trophoblastic Differentiation
More than 30 cases of urothelial carcinoma with areas of trophoblastic differentiation have been reported and a small subset has had symptoms related to excess human chorionic gonadotropin production including gynecomastia., , , , Although some of the early reports have described tumors that apparently were composed solely of tissue resembling choriocarcinoma, most tumors reported in the last three decades or so have been composed of a mixture of urothelial carcinoma with trophoblastic elements. A single case of micropapillary carcinoma with trophoblastic elements has been reported.
Figure 11
Urothelial carcinoma with trophoblastic differentiation. Choriocarcinoma component with biphasic histology including syncytiotrophoblastic giant cells.
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Treatment Options For Bladder Cancer At Moffitt
At Moffitt Cancer Center, the multispecialty team in our Genitourinary Oncology Program will work together to diagnose your cancer and develop the best possible individualized treatment plan, always focused on preserving a positive quality of life. We are the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and one of just 51 across the country. Focused, individualized attention from leading experts in the research and treatment of all types of bladder cancer thats the kind of assurance you need to put your mind at ease.
You dont need a referral to contact Moffitt Cancer Center, so call us at , or fill out a new patient registration form online to begin exploring the ways in which we can partner with you to return you to health.
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Bladder Cancer Clinical Trials
What about Clinical Trials?
You may hear about clinical trials for your bladder cancer. Clinical trials are research studies that test if a new treatment or procedure is safe and effective.
Through clinical trials, doctors find new ways to improve treatments and the quality of life for people with disease. Trials are available for all stages of cancer. The results of a clinical trial can make a major difference to patients and their families. Please visit our clinical trials research webpage to learn more.
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Aua : Researchers Find Early Stage Micropapillary Bladder Cancer Outcomes Similar To Late
A recent study from Fox Chase Cancer Center has found that in patients treated with radical cystectomy – removal of the bladder – those with cT1 micropapillary bladder cancer had similar or worse oncological outcomes compared with patients with cT2 conventional urothelial carcinoma.
Results from this study will be presented at the virtual American Urological Association 2021 Annual Meeting.
The designations cT1 and cT2 refer to the stages at which the cancer has developed, an important step in helping physicians determine the appropriate treatment.
Micropapillary bladder cancer is a rare and often aggressive variant of bladder cancer, which poses a very difficult treatment dilemma when diagnosed in the non-muscle invasive stage because it often presents at an advanced stage. When its caught at an early stage, its very difficult to know what to do with it because it is such an aggressive variant, said Kevin Ginsburg, MD, lead author on the study and second-year fellow in the Urologic Oncology Fellowship Program at Fox Chase.
To help determine the best course of treatment for this cancer, the researchers reviewed the National Cancer Database for patients undergoing radical cystectomy for cT1 micropapillary bladder cancer and conventional cT1/cT2 urothelial carcinoma from 2004 to 2016.
Researchers were able to find more than 25,000 patients who underwent cystectomy in the database, including only 125 who had been diagnosed with cT1 micropapillary bladder cancer.
Types Of Bladder Cancer
The type of bladder cancer depends on how the tumors cells look under the microscope. The 3 main types of bladder cancer are:
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Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It also accounts for 10% to 15% of kidney cancers diagnosed in adults. It begins in the urothelial cells that line the urinary tract. Urothelial carcinoma used to be called transitional cell carcinoma or TCC.
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Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time, these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.
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Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.
There are other, less common types of bladder cancer, including micropapillary, plasmacytoid, sarcomatoid carcinoma of the bladder, and small cell bladder cancer, among others. Sarcomas of the bladder often begin in the fat or muscle layers of the bladder. Small cell bladder cancer is a rare type of bladder cancer that is likely to spread to other parts of the body.
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Histologic Variants Of Urothelial Carcinoma: Morphology Molecular Features And Clinical Implications
Article type: Review Article
Authors: Alderson, Meeraa | Grivas, Petrosb | Milowsky, Matthew I.c d | Wobker, Sara E.d e *
Affiliations: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA | University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA | Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA | UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA | Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
Correspondence: Corresponding author: Sara E. Wobker MD, MPH, University of North Carolina at Chapel Hill, 303 Brinkhous-Bullitt Bldg, CB#7525, Chapel Hill, NC 27599, USA. Tel.: +1 984 974 9156 Fax: +1 984 974 9177 E-mail: .
Keywords: Urothelial carcinoma, bladder cancer, histologic variant
DOI: 10.3233/BLC-190257
Journal: Bladder Cancer, vol. 6, no. 2, pp. 107-122, 2020
Abstract
Cancerous Tumours Of The Bladder
A cancerous tumour of the bladder can grow into nearby tissue and destroy it. It can also spread to other parts of the body. Cancerous tumours are also called malignant tumours.
Bladder cancer is often divided into 3 groups based on how much it has grown into the bladder wall.
- Non-invasive bladder cancer is only in the inner lining of the bladder .
- Non–muscle-invasive bladder cancer has only grown into the connective tissue layer .
- Muscle-invasive bladder cancer has grown into the muscles deep within the bladder wall and sometimes into the fat that surrounds the bladder.
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There Are Different Types Of Treatment For Patients With Bladder Cancer
Different types of treatment are available for patients with bladder cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
What Are The Treatment Options For Bladder Cancer
There are four types of treatment for patients with bladder cancer. These include:
- Surgery
Sometimes, combinations of these treatments will be used.
Surgical options
Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.
- Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
- Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
- Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .
This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.
Chemotherapy
- Methotrexate
Intravesical therapy
Radiation therapy
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What Are The Risk Factors For Bladder Cancer
Some factors increase the risk of bladder cancer:
- Cigarette smoking is the biggest risk factor it more than doubles the risk. Pipe and cigar smoking and exposure to second-hand smoking may also increase one’s risk.
- Prior radiation exposure is the next most common risk factor .
- Certain chemotherapy drugs also increase the risk of bladder cancer.
- Environmental exposures increase the risk of bladder cancer. People who work with chemicals, such as aromatic amines are at risk. Extensive exposure to rubber, leather, some textiles, paint, and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
- Infection with a parasite known as Schistosoma haematobium, which is more common in developing countries and the Middle East.
- People who have frequent infections of the bladder, bladder stones, or other diseases of the urinary tract, or who have chronic need for a catheter in the bladder, may be at higher risk of squamous cell carcinoma.
- Patients with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.
Other risk factors include diets high in fried meats and animal fats, and older age. In addition, men have a three-fold higher risk than women.