What Is The Most Common Type Of Bladder Cancer
Urothelial carcinoma, also called transitional cell carcinoma, is the most common type of bladder cancer, accounting for approximately 9 out of every 10 cases.2 This type of cancer starts in the urothelial cells lining the inner surface of the bladder wall. Cancerous urothelial cells form a tumor that can grow into the deeper layers of the bladder wall and spread to nearby lymph nodes and organs. In some instances, cancer cells may break away from the bladder tumor and form new tumors in distant parts of the body. This is called metastatic bladder cancer.
Urothelial carcinoma bladder tumors may be classified as non-muscle invasive or muscle invasive and assigned to a specific T category according to the nature and extent of their growth.
Treating Stage I Bladder Cancer
Stage I bladder cancers have grown into the connective tissue layer of the bladder wall , but have not reached the muscle layer.
Transurethral resection with fulguration is usually the first treatment for these cancers. But it’s done to help determine the extent of the cancer rather than to try to cure it. If no other treatment is given, many people will later get a new bladder cancer, which often will be more advanced. This is more likely to happen if the first cancer is high-grade .
Even if the cancer is found to be low grade , a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG or intravesical chemo is usually given. If all of the cancer wasn’t removed, options are intravesical BCG or cystectomy .
If the cancer is high grade, if many tumors are present, or if the tumor is very large when it’s first found, radical cystectomy may be recommended.
For people who arent healthy enough for a cystectomy, radiation therapy might be an option, but the chances for cure are not as good.
Early Warning Signs Of Bladder Cancer
Blood in the urine : This is typically the first sign of bladder cancer. It may be present on a regular basis or disappear and reappear over the course of days or weeks. Sometimes blood is present in such a small amount that it cant be seen with the naked eye, called microscopic hematuria, buta urine test may be able to detect it.
Even a small amount of blood may cause the color of urine to change to orange, pink or, rarely, dark red. When blood causes urines color to change, its called gross hematuria.
Early-stage bladder cancer doesn’t usually cause pain or other symptoms besides bleeding. But blood in the urine doesn’t always mean there’s a tumor in the bladder. It’s more likely to be caused by a less serious condition, such as an infection. kidney stones, bladder stones, or noncancerous tumors or kidney diseases.
Its also important to note that blood from menstruation may show up in a womans urine test, which may cause a false-positive test result. In this case, doctors may recommend repeating the test.
Urination changes: Changes in urination are more commonly a sign of a less serious condition, such as a benign tumor, infection, urinary tract infection, bladder stones, an overactive bladder or, in men, an enlarged prostate. But they also may be another early sign of bladder cancer symptoms. These changes may include:
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Other Terms Often Used To Describe Bladder Cancer
Although bladder cancer types are assigned based on the cells that the cancer originates from, several other terms may be used to describe the disease.
- Advanced bladder cancer is another term that may be used to describe metastatic bladder cancer. It means that the cancer has spread to distant parts of the body such as the lungs, bones, liver, or lymph nodes outside the pelvis.
- Locally advanced bladder cancer refers to cancer that has grown through the bladder wall, and possibly into nearby lymph nodes or organs, but has not spread to distant sites in the body.
- Bladder cancer stage describes where the cancer is located within the bladder and any sites of spread. As described above, the TNM staging system assigns a patients bladder cancer to a tumor , lymph node and metastasis category. These categories may also be combined to give an overall stage number: an overall stage of 0 or 1 describes early disease, while stage 4 is the most advanced. For further information regarding staging, see Bladder Cancer Stages.
- Bladder cancer grade is based on the microscopic appearance of cancer cells and suggests how fast a cancer might grow. Low-grade cancer cells appear similar to normal cells and usually grow slowly, whereas high-grade cancer cells have a very abnormal appearance and tend to grow quickly. High-grade cancers are more likely than low-grade cancers to spread.
There Are Three Ways That Cancer Spreads In The Body
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
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Lymphadenectomy: Role And Extent
Controversies in evaluating the clinical significance of lymphadenectomy are related to two main aspects of nodal dissection: therapeutic procedure and/orstaging instrument.
Two important autopsy studies have been performed for RC so far. The firststudy showed that in 215 patients with MIBC and nodal dissemination, the frequency ofmetastasis was 92% in regional , 72% in retroperitoneal, and 35% inabdominal LNs. There was also a significant correlation between nodal metastases andconcomitant distant metastases . Approximately 47% of the patients had bothnodal metastases and distant dissemination and only 12% of the patients had nodaldissemination as the sole metastatic manifestation .
The second autopsy study focused on the nodal yield whensuper-extended pelvic LND was performed. Substantial inter-individual differences were foundwith counts ranging from 10 to 53 nodes . These findingsdemonstrate the limited utility of node count as a surrogate for extent of dissection.
Regional LNs have been shown to consist of all pelvic LNsbelow the bifurcation of the aorta . Mapping studiesalso found that skipping lesions at locations above the bifurcation of the aorta withoutmore distally located LN metastases is rare .
Surgery For Stage Ii Or Iii
Most patients with stage II or stage III bladder cancer will have part or all of their bladder removed. This is called a cystectomy. A partial cystectomy is when only a part of the bladder is removed. A radical cystectomy is a surgery to remove all of the bladder:
- In men, the surgery removes the entire bladder as well as the prostate and seminal vesicles.
- In women, the bladder is removed along with the uterus, ovaries, and part of the vagina.
- Some stage IV patients may be offered surgery.
Your surgeon will reconstruct your urinary tract if your bladder is removed.
Before you have bladder removal and reconstruction:
- Find a surgeon who performs the surgeries often.
- Ask questions like: How will your reconstruction work? How long will you be in the hospital? What complications may you experience? How long will it take to recover? How may the surgery affect your sexual functioning?
- Talk to your doctor about the lifelong follow-up you will need. Your health care team will check your reconstruction and address bladder stones or other health problems.
- Be aware that you may experience incontinence or urine leakage, no matter what reconstruction you choose.
- Get support as you learn to use your new bladder. Specialized urology nurses and wound/ostomy nurses can help you in recovery.
- Join an in-person or online support group to connect with other bladder cancer patients.
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Treatment For Gall Bladder Cancer
Discussion with your doctor will help you decide on the best treatment for your cancer depending on the type of cancer you have whether or not the cancer has spread your age, fitness and general health and your preferences.
The main treatments for gall bladder cancer include surgery, radiation therapy and chemotherapy. These can be given alone or in combination.
Rare Forms Of Bladder Cancer
Adenocarcinomas account for less than 2% of primary bladder tumors. These lesions are observed most commonly in exstrophic bladders and are often associated with malignant degeneration of a persistent urachal remnant.
Other rare forms of bladder cancer include leiomyosarcoma, rhabdosarcoma, carcinosarcoma, lymphoma, and small cell carcinoma. Leiomyosarcoma is the most common sarcoma of the bladder. Rhabdomyosarcomas most commonly occur in children. Carcinosarcomas are highly malignant tumors that contain a combination of mesenchymal and epithelial elements. Primary bladder lymphomas arise in the submucosa of the bladder. Except for lymphomas, all these rare bladder cancers carry a poor prognosis.
Small cell carcinoma of the urinary bladder is a poorly differentiated, malignant neoplasm that originates from urothelial stem cells and has variable expression of neuroendocrine markers. Morphologically, it shares features of small cell carcinoma of other organs, including the lung.
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Causes Of Bladder Cancer
Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells over many years.
Tobacco smoke is a common cause and it’s estimated that more than 1 in 3 cases of bladder cancer are caused by smoking.
Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned.
Read more about the causes of bladder cancer.
Comorbidity Scales Anaesthetic Risk Classification Andgeriatric Assessment
A range of comorbidity scales has been developed , seven of which have been validated . The Charlson Comorbidity Index ranges from 0 to30 according to the importance of comorbidity described at four levels and is calculated byhealthcare practitioners based on patients medical records. The score has been widelystudied in patients with BC and found to be an independent prognostic factor forperi-operative mortality , overallmortality , and CSM . Only the age-adjusted version of the CCI wascorrelated with both cancer-specific and other-cause mortality . The age-adjusted CCI is the most widely usedcomorbidity index in cancer for estimating long-term survival and is easily calculated .
Health assessment of oncology patients must be supplemented by measuringtheir activity level. Extermann et al. have shown thatthere is no correlation between morbidity and competitive activity level . The Eastern Cooperative Oncology Group performancestatus scores and Karnofsky index have been validated to measure patient activity . Performance score is correlated with patient OS after RC and palliative chemotherapy .
Table 5.2: Calculation of the Charlson Comorbidity Index
Number of points
Both patient and tumour characteristics guide treatment decisions andprognosis of patients with MIBC.
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What Is Bladder Cancer
Bladder cancer starts in the cells of the bladder. A cancerous tumour is a group of cancer cells that can grow into nearby tissue and destroy it. The tumour can also spread to other parts of the body.
The bladder is part of the urinary system . It is a hollow organ in the pelvis that stores urine before it passes out of the body.
Cells in the bladder sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous tumours such as papillomas. They can also lead to non-cancerous conditions such as urinary tract infections .
But in some cases, changes to bladder cells can cause bladder cancer. Most often, bladder cancer starts in urothelial cells that line the inside of the bladder. This type of cancer is called urothelial carcinoma of the bladder . Urothelial carcinomas make up more than 90% of all bladder cancers. They are often diagnosed at an early stage and have not grown into the deeper muscle layer of the bladder wall.
Rare types of bladder cancer can also develop. These include squamous cell carcinoma and adenocarcinoma of the bladder.
Treating Bladder Cancer That Progresses Or Recurs
If cancer continues to grow during treatment or comes back after treatment , treatment options will depend on where and how much the cancer has spread, what treatments have already been used, and the patient’s overall health and desire for more treatment. Its important to understand the goal of any further treatment if its to try to cure the cancer, to slow its growth, or to help relieve symptoms as well as the likely benefits and risks.
For instance, non-invasive bladder cancer often comes back in the bladder. The new cancer may be found either in the same place as the original cancer or in other parts of the bladder. These tumors are often treated the same way as the first tumor. But if the cancer keeps coming back, a cystectomy may be needed. For some non-invasive tumors that keep growing even with BCG treatment, and where a cystectomy is not an option, immunotherapy with pembrolizumab might be recommended.
Cancers that recur in distant parts of the body can be harder to remove with surgery, so other treatments, such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy, might be needed. For more on dealing with a recurrence, see Understanding Recurrence.
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Treating Stage 0 Bladder Cancer
Stage 0 bladder cancer includes non-invasive papillary carcinoma and flat non-invasive carcinoma . In either case, the cancer is only in the inner lining layer of the bladder. It has not invaded the bladder wall.
Five Types Of Standard Treatment Are Used:
One of the following types of surgery may be done:
- Transurethral resection with fulguration: Surgery in which a cystoscope is inserted into the bladder through the urethra.A tool with a small wire loop on the end is then used to remove thecancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
- Radical cystectomy: Surgery to remove the bladder and anylymph nodes and nearby organs that contain cancer. This surgery may bedone when the bladder cancer invades the muscle wall, or when superficialcancer involves a large part of the bladder. In men, the nearby organs that areremoved are the prostate and the seminal vesicles. In women, the uterus, theovaries, and part of the vagina are removed. Sometimes, when the cancer hasspread outside the bladder and cannot be completely removed, surgery to removeonly the bladder may be done to reduce urinarysymptoms caused by the cancer.When the bladder must be removed, the surgeon creates another way for urine toleave the body.
- Partial cystectomy: Surgery to remove part of thebladder. This surgery may be done for patients who have a low-grade tumor thathas invaded the wall of the bladder but is limited to one area of the bladder.Because only a part of the bladder is removed, patients are able to urinate normally afterrecovering from this surgery. This is also called segmental cystectomy.
- Urinary diversion: Surgery to make a new way forthe body to store and pass urine.
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Histopathological And Clinical Markers
The most important histopathological prognostic variables after RC and LNdissection are tumour stage and LN status . In addition, otherhistopathological parameters of the RC specimen have been associated with prognosis.
The value of lymphovascular invasion was reported in asystematic review and meta-analysis including 78,000 patients from 65 studies treated withRC for BC . Lymphovascular invasion was present in 35% of thepatients and correlated with a 1.5-fold higher risk of recurrence and CSM, independent ofpathological stage and peri-operative chemotherapy. This correlation was even stronger inthose patients with node-negative disease .
In a systematic review andmeta-analysis including 23 studies and over 20,000 patients, the presence of concomitantCIS in the RC specimen was associated with a higher odds ratio of ureteralinvolvement . Concomitant CIS was not independentlyassociated with OS, recurrence-free survival and DSS in all patients, but inpatients with organ-confined disease concomitant CIS was associated with worse RFS and CSM .
Tumour location has been associated with prognosis. Tumours located at thebladder neck or trigone of the bladder appear to have an increased likelihood of nodalmetastasis and have been associated with decreasedsurvival .
Cancer That Has Spread To The Bladder
Sometimes cancer that has started elsewhere in the body can spread to the bladder. This can happen with prostate, rectum, ovary, cervix and womb cancer for example.
Cancers that have spread from somewhere else in the body are called secondary cancers. The cancer cells are the same type as the first cancer. So is the treatment.
If you have cancer that has spread to the bladder, you need to go to the section about your primary cancer.
Cancer and Its Management J Tobias and D HochhauserWiley Blackwell, 2015
A M Kamat and othersThe Lancet, 2016. Volume 388, Pages 276 -2810
AJCC Cancer Staging Manuel American Joint Committee on CancerSpringer, 2017
Bladder cancer: diagnosis and management of bladder cancerNational Institute of Health and Clinical Excellence, 2015
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Case Authors Lament Scant Information On Treatments Or Outcomes
byKate Kneisel, Contributing Writer, MedPage Today April 26, 2021
A 59-year-old man presents to a hospital in Yokohama, Japan, after being referred by his local medical provider for further workup regarding gross hematuria. He has no other symptoms.
Clinicians perform cystoscopy, followed by CT and MRI scans, which identify a nodular tumor that occupies the patients bladder it is 8 cm in diameter.
Aside from being a tobacco smoker, the patients medical history is unremarkable. Laboratory tests are performed but fail to identify any abnormalities. The patient undergoes transurethral resection of the bladder tumor, which is sent to histology for analysis.
The pathology report reveals the tumor as the sarcomatoid variant of urothelial carcinoma with a heterologous osteosarcomatous element of osteosarcoma and high-grade spindle cells. The patient refuses to undergo the radical cystectomy proposed by clinicians, opting instead to undergo another transurethral resection of the tumor.
The specimen from the second surgery reveals the same elements, with evidence of invasion to the muscle. Based on these findings, clinicians schedule the patient for two courses of neoadjuvant chemotherapy with gemcitabine and cisplatin they recommend that this be followed by a radical cystectomy.
At that point, the patient is unable to undergo radical cystectomy. Six months after his initial consultation, the patient succumbs to cancer of the bladder.