What Is Muscle Invasive Bladder Cancer
Muscle invasive bladder cancer is a cancer that spreads into the detrusor muscle of the bladder. The detrusor muscle is the thick muscle deep in the bladder wall. This cancer is more likely to spread to other parts of the body.
In the U.S., bladder cancer is the third most common cancer in men. Each year, there are more than 83,000 new cases diagnosed in men and women. About 25% of bladder cancers are MIBC. Bladder cancer is more common as a person grows older. It is found most often in the age group of 75-84. Caucasians are more likely to get bladder cancer than any other ethnicity. But there are more African-Americans who do not survive the disease.
What is Cancer?
Cancer is when your body cells grow out of control. When this happens, the body cannot work the way it should. Most cancers form a lump called a tumor or a growth. Some cancers grow and spread fast. Others grow more slowly. Not all lumps are cancers. Cancerous lumps are sometimes called malignant tumors.
What is Bladder Cancer?
When cells of the bladder grow abnormally, they can become bladder cancer. A person with bladder cancer will have one or more tumors in his/her bladder.
How Does Bladder Cancer Develop and Spread?
The bladder wall has many layers, made up of different types of cells. Most bladder cancers start in the urothelium or transitional epithelium. This is the inside lining of the bladder. Transitional cell carcinoma is cancer that forms in the cells of the urothelium.
Stage 2 Bladder Cancer
A diagnosis of stage 2 bladder cancer means that the bladder cancer cells have grown into the muscle layer of the bladder wall.1,2 This is also called muscle-invasive bladder cancer. Stage 2 bladder cancer includes the following combined TNM stages:
In both of those types of stage 2 bladder cancer, the cancer cells have not grown into the nearby lymph nodes and they have not spread to other parts of the body. The muscle portion of the bladder wall has two layers. The inner half, closest to the bladder lining, is called the superficial muscle. The outer half is also called the deep muscle of the bladder. If the tumor is type T2a, it means that the cancer cells have spread into the superficial muscle, but not into the deep muscle. If the tumor is type T2b, the bladder cancer cells have grown through the superficial muscle and into the deep muscle of the bladder. However, the cancer cells have not yet spread into the layer of fatty tissue that surrounds the outer part of the bladder muscle.
Mechanistic Interactions Between Bladder Cancer And Aging
Several broad hypotheses have proposed potential mechanisms for the association between cancer and aging, whereby the biological processes of aging could influence the development and/or progression of cancer in older adults. The processes interact at multiple levels for example, tumor protein 53 a tumor suppressoris involved in both cancer and aging: alteration of the p53 gene is the most frequently encountered mutation in human cancers , and the efficiency of the response to p53 has been found to vary according to age. In a mouse study, Feng et al. reported that the efficiency of the p53 response was significantly reduced in older mice compared with their younger counterparts. The reduced response predominantly resulted from decreased transcriptional activity and p53-dependent apoptosis decreased stabilization of p53 after stress was found to be the major factor in this decline.
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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> .
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Adenocarcinoma And Small Cell Carcinoma
Adenocarcinoma and small cell carcinoma are rare forms of bladder cancer. Each makes up about one percent of bladder cancers, according to Memorial Sloan Kettering Cancer Center.
Adenocarcinoma is linked to inflammation and chronic infection as well as bladder defects at birth. Small cell carcinoma begins in the small nerve-like cells in the bladder and is an aggressive cancer.
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Cystoscopy With Cautery Destruction Of The Bladder Tumor
Cystoscopy is an outpatient procedure during which a thin, lighted tube with a camera is passed through the urethra into the bladder, allowing your doctor to see the inside of the bladder.
Most modern cystoscopes are also equipped with channels that permit small instruments to be passed into the bladder. During a cystoscopy, your doctor may use these instruments to remove tissue, stop bleeding with a special electrical device called an electrocautery or even perform laser treatment. If the bladder cancer tumor is small enough, this cautery may be used to remove the cancer.
What Is Stage 2 Cancer
Stage 2 cancers are typically larger than stage 1 cancers and/or have spread to nearby lymph nodes. Like stage 1 cancers, stage 2 cancers are typically treated with local therapies such as surgery or radiation therapy.
Stage 2 cancer is determined in the five most common cancers in the following way:
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Intermediate Risk Early Bladder Cancer
People with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least 6 doses of chemotherapy. The liquid is placed directly into your bladder, using a catheter, and kept there for around an hour before being drained away.
You should be offered follow-up appointments at 3, 9 and 18 months, then once every year. At these appointments, your bladder will be checked using a cystoscopy. If your cancer returns within 5 years, you’ll be referred back to a specialist urology team.
Some of the chemotherapy medicine may be left in your urine after treatment, which could severely irritate your skin.
It helps if you sit down to urinate and that you’re careful not to splash yourself or the toilet seat. Always wash the skin around your genitals with soap and water afterwards.
If you’re sexually active, it’s important to use a barrier method of contraception, such as a condom. This is because the medicines may be present in your semen or vaginal fluids, which can cause irritation.
You also shouldn’t try to get pregnant or father a child while having chemotherapy for bladder cancer, as the medicines can increase the risk of having a child with birth defects.
Transurethral Resection Of The Bladder Cancer Tumor
This is when the tumor is removed from the urinary tract through the urethra using an electrical force. Transurethral resection is an endoscopic or scope procedure that does not involve making an incision in the body.
Drug therapy after TUR is commonly prescribed for patients with large, multiple or high-grade tumors.
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What Goes Into A Prognosis
When figuring out your prognosis, your healthcare provider will consider all the things that could affect the cancer and its treatment. He or she will look at risk estimates about the exact type and stage of the cancer you have. These estimates are based on what results researchers have seen over many years in thousands of people with the same type and stage of cancer.
If your cancer is likely to respond well to treatment, your healthcare provider will say you have a favorable prognosis. This means youre expected to live many years and may even be cured. If your cancer is likely to be hard to control, your prognosis may be less favorable. The cancer may shorten your life. Its important to keep in mind that a prognosis states whats likely or probable. It’s not a prediction of what will definitely happen. No healthcare provider can be fully certain about an outcome.
Your prognosis depends mainly on:
The type and location of the cancer
The stage of the cancer
Your overall health
Your treatment decisions
Treatment Of Stage I Bladder Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage I bladder cancer may include the following:
- Transurethral resection with fulguration. This may be followed by one of the following:
- Intravesicalchemotherapy given right after surgery.
- Intravesical chemotherapy given right after surgery and then regular treatments with intravesical BCG or intravesical chemotherapy.
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Questions To Ask Your Physician About The Treatment Of Stage Ii
- What are the long-term results of treatment with radical cystectomy at the treating institution?
- What is the quality of life with the type of artificial bladder constructed at the treating institution?
- What are the long-term results of bladder-sparing treatments at the treating institution?
- How will systemic therapy improve my outcome compared to treatment with surgery alone?
- Can MRD assessment be used to improve treatment?
Systemic Therapy Prior To Cystectomy
Following a radical cystectomy, local recurrence of cancer is uncommon because the cancer and bladder are removed. Some patients however will still develop distant recurrences because undetected cancer cells called micrometastases spread to other locations in the body before the bladder was removed. Treatment with a systemic therapy such as chemotherapy or immunotherapy may reduce or eliminate these micrometastases reducing the risk of cancer recurrence and avoid cystectomy.
Neoadjuvant therapy refers to systemic therapy that is given before surgery. The rationale behind neoadjuvant therapy for bladder cancer is twofold. First, pre-operative treatment can shrink some bladder cancers and therefore, may allow more complete surgical removal of the cancer. Second, because systemic therapy kills undetectable cancer cells in the body, it may help prevent the spread of cancer when used initially rather than waiting for patient recovery following the surgical procedure.
A study published in the New England Journal of Medicine reported that patients with muscle-invasive bladder cancer who received chemotherapy prior to cystectomy had better survival than patients treated with cystectomy alone.1
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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.
Whats The Treatment For Stage 2 Bladder Cancer
Your treatment options will depend on a number of factors, such as your age and general health. Youll probably need a combination of treatments. Your doctor will monitor your progress and adjust therapy as needed. You may also need treatments to help control symptoms of cancer and side effects of treatment.
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What Are The Survival Rates For Bladder Cancer
If the cancer is just on the inner lining of the bladder , the 5-year survival rate is about 98%.
If the cancer is growing just beyond the inner lining into the bladder wall, but is still just in the bladder , the 5-year survival rate is about 88%.
Those with bladder cancer that’s spread into the muscular wall of the bladder, but not outside the bladder, or to nearby lymph nodes or organs have a 5-year survival rate of about 63%.
If the cancer has spread through the bladder muscle into the layer of tissue around the bladder and maybe to nearby organs , but has not spread to lymph nodes or other organs , the 5-year survival rate is about 46%.
When bladder cancer has moved beyond the bladder to the pelvic or abdominal wall, to lymph nodes, or to distant parts of the body , the 5-year survival rate is about 15%.
Treatment Of Stage Iv Bladder Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage IV bladder cancer that has not spread to other parts of the body may include the following:
- Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.
- External radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
- A clinical trial of new anticancer drugs.
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Bladder Cancer Survival Rates
Survival rates dont tell a person how long they will live, but they can predict how likely it is that treatment will succeed. People whose cancer hasnt grown past the bladder have a better at living for at least five years with treatment.
These are just guidelines and dont necessarily apply to each individual persons case. If you have questions about your specific prognosis and survival chances, talk to your doctor.
National Cancer Institute Five-Year Survival Rates
- Average overall 77 percent
Treatment Options Under Clinical Evaluation For Patients With Any T Any N M1 Disease
Prognosis is poor in patients with stage IV disease and consideration of entry into a clinical trial is appropriate.
Other chemotherapy regimens appear to be active in the treatment of metastatic disease. Chemotherapy agents that have shown activity in metastatic bladder cancer include paclitaxel, docetaxel, ifosfamide, gallium nitrate, and pemetrexed.
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Bladder Cancer Survival Rate: What To Expec
Rectal Cancer Survival Calculator. Disclaimer: This calculator is not meant to be a substitute for medical opinions by qualified physicians regarding cancer treatment. Results from this calculator should only be used in conjunction with all other clinical information in each case Abdollah F, Gandaglia G, Thuret R et al: Incidence, survival and mortality rates of stage-specific bladder cancer in United States: a trend analysis. Cancer Epidemiol 2013 37:219. Nielsen ME, Smith AB, Meyer AM et al: Trends in stage-specific incidence rates for urothelial carcinoma of the bladder in the United States: 1988 to 2006 SCCB is extremely rare with an annual incidence of less than 1-9/1,000,000. Since 1980, fewer than 1,500 cases have been identified. The demographic profile of SCCB is similar to that of patients with bladder transitional cell carcinoma The bladder can hold about half of a liter of urine and expands, but a person usually feels the urge to urinate when the bladder is 25% full. When it is empty, the bladder will contract and become smaller. Due to the bladder’s skill to expand and contract, it’s thought of as a balloon that was muscle
How Long Will You Live If You Have Bladder Cancer
The survival rate depends on the stage of cancer at diagnosis and other health issues.
Overall, 70 to 90 percent of people with localized bladder cancer will live for at least five years or more. The physician calculates this with the help of survival rates. Survival rates indicate the percentage of people who live with a certain type of cancer for a specific time. The physician often uses an overall five-year survival rate. Factors that may affect survival rate include
Table. Five-year survival rates of different stages of bladder cancer
|Bladder cancer SEER stages||Five-year relative survival rate|
|In situ alone||96|
|All SEER stages combined||77|
The surveillance, epidemiology, and end results stages are taken from the SEER database, maintained by the National Cancer Institute. SEER database groups cancers into localized, regional, and distant stages.
- Localized: There is no indication that cancer has spread outside the bladder.
- Regional: Cancer has invaded the nearby structures or lymph nodes.
- Distant: Cancer has spread to distant parts of the body, such as the lungs, liver, or bones.
Thus, bladder cancer, if detected in the early stage is treatable and has higher survival rates. However, if the cancer is detected in the advanced stages, treatment becomes difficult and the survival rate is low.
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