Sunday, December 10, 2023

What Are The Different Stages Of Bladder Cancer

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

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

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:

Risk Factors For Bladder Cancer

There are some things that can make you more likely to develop bladder cancer. These are called risk factors and they include:

  • smoking chemicals in cigarettes can cause bladder cancer, so if you smoke, your risk is up to 3 times that of a non-smoker
  • age most people with bladder cancer are over 60 years of age
  • being male men are around 3 times more likely than women to develop bladder cancer
  • chemicals being in contact with certain chemicals for a long period of time, like aromatic amines, benzene products and aniline dyes, which have been linked to bladder cancer
  • chronic infections frequent infections of the bladder over a long period of time
  • previous cancer treatments some types of radiation therapy around the pelvis, and the chemotherapy drug cyclophosphamide
  • family history a first degree relative with bladder cancer increases risk up to nearly 2 times higher than the general population.

Having these risk factors doesnt mean you will develop bladder cancer. Often there is no clear reason for getting bladder cancer. If you are worried about your risk factors, ask your doctor for advice.

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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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.

Researching Stage 4 Cancer Alternatives

Illustration of different pathological stages of bladder cancer. Stage ...

So it wasnt my first bout with cancer either. So, the medical establishment just had nothing at all to offer me. So, I went home and between my husband and I we got on the internet and were looking for alternatives.

Early on in my research I came across a report on a clinical trial done by Dr. Santori and Warburg, who actually won the Nobel peace prize in medicine for curing cancer with cesium.** And because I found that clinical trial pretty early on in my research, I decided that if it was good enough for a Nobel peace prize you know it was probably good enough for me.

**A Note About Warburg and SartoriNeither Dr. Sartori nor Dr. Warburg earned Nobel prizes for curing cancer with cesium chloride. Otto Warburg did win the Nobel Prize in Physiology and Medicine in 1931 for his investigation of the metabolism of tumors and the respiration of cells, particularly cancer cells. He wrote The Prime Cause and Prevention of Cancer based on his years of research and was nominated for the Nobel Prize award 47 times over the course of his career. H.E. Sartori, M.D. researched the affects of diet and nutrition on cancer occurrence. He wrote Cesium Therapy in Cancer Patients in 1984 about a study he conducted using cesium chloride therapy on 50 patients with cancer.

Larry: Right.

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After Bladder Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Bladder Or To Other Parts Of The Body

The process used to find out if cancer has spread within thebladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

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:

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    Types And Stages Of Bladder Cancer

    Like with most cancers, there are different types and stages of bladder cancer. If you have recently been given a diagnosis or are waiting to hear what’s changed following treatment, this page explains what the different terms mean. It can be a lot to take in so don’t feel that you have to read all this at once. You can order or download booklets which cover your diagnosis and speak to our helpline team or visit our forum. There are links at the bottom of this page with all the details.

    More information on the types and stages of bladder cancer are available in our patient booklets .

    The most important thing to remember is that you are not alone. We are here to support you however we can.

    Patient Stories & Blog

    Bladder Cancer: What to Know If Youâve Just Been Diagnosed

    We are very grateful to everyone who has shared their story with us on this website. We know that many people find reading the story of other patients very helpful when trying to make sense of their diagnosis or cancer journey. We also know that these stories can be very powerful in helping to raise awareness of bladder cancer and highlight the urgent need for new treatments, research and support for those with bladder cancer.

    If you would like to tell your story please do get in touch with us by email at

    We can arrange for one of our Patient Support Officers to get in touch to help you tell your story, if that would be helpful, and we also have a hints and tips sheet to give you more ideas about what to write.

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    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.

    Genetic Factors In Pathogenesis

    Divergent, yet interconnected and overlapping, molecular pathways are likely responsible for the development of noninvasive and invasive bladder tumors. Somatic mutations in fibroblast growth receptor3 and tumor protein p53 in tumor cells appear to be important early molecular events in the noninvasive and invasive pathways, respectively.

    FGFR-3, Ras, and PIK3CA mutations occur with high frequency in noninvasive tumors, leading to upregulation of Akt and mitogen-activated protein kinase . Loss of heterozygosity on chromosome 9 is among the most frequent genetic alterations in bladder tumors and is considered an early event.

    Large numbers of genomic changes have been detected using karyotyping and comparative genomic hybridization analysis in urothelial carcinoma. Numerically common are losses of 2q, 5q, 8p, 9p, 10q, 18q, and Y. Gains of 1q, 5p, 8q, and 17q are frequently present, and high-level amplifications can be found however, the target genes in the regions of amplifications have not been conclusively identified.

    Alterations in the TP53 gene are noted in approximately 60% of invasive bladder cancers. Progression-free survival is significantly shorter in patients with TP53 mutations and is an independent predictor of death among patients with muscle-invasive bladder cancer.

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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.

    Stage 0 Bladder Cancer

    Non

    Stage zero bladder cancers are called noninvasive papillary carcinoma and carcinoma in situ. Theyre precancerous lesions that could develop into more serious cancers if not treated.

    These growths develop on the inner lining of the bladder. Noninvasive papillary carcinoma, also called stage 0a, forms long, thin growths into the empty space inside the bladder.

    Carcinoma in situ, also called stage 0is bladder cancer, forms flatter growths that tend to be of a wilder grade. It is considered a more aggressive disease and is more likely to spread into the muscular walls of the bladder.

    According to the National Cancer Institutes SEER database of cancer statistics, about half of bladder cancers are diagnosed at stage 0.

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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.

    N Categories For Bladder Cancer

    The N category describes spread only to the lymph nodes near the bladder and those along the blood vessel called the common iliac artery. These lymph nodes are called regional lymph nodes. Any other lymph nodes are considered distant lymph nodes. Spread to distant nodes is considered metastasis . Surgery is usually needed to find cancer spread to lymph nodes, since this is seldom seen on imaging tests.

    The N categories are described in the table above, except for:

    NX: Regional lymph nodes cannot be assessed due to lack of information.

    N0: There’s no regional lymph node spread.

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    Other Types Of Bladder Cancer

    Approximately 2% of bladder cancers are adenocarcinomas. Nonurothelial primary bladder tumors are extremely rare and may include small cell carcinoma, carcinosarcoma, primary lymphoma, and sarcoma . Small cell carcinoma of the urinary bladder accounts for only 0.3-0.7% of all bladder tumors. High-grade urothelial carcinomas can also show divergent histologic differentiation, such as squamous, glandular, neuroendocrine, and sarcomatous features.

    Treatment Of Recurrent Bladder Cancer

    Understanding Advanced Bladder Cancer

    For information about the treatments listed below, see the Treatment Option Overview section.

    Treatment of recurrentbladder cancer depends on previous treatmentand where the cancer has recurred. Treatment for recurrent bladder cancer mayinclude the following:

    Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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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.

    Prognosis And Survival Rates For Bladder Cancer

    When someone is diagnosed with bladder cancer, their doctor will give them a prognosis. A prognosis is the doctors opinion of how likely the cancer will spread and the chances of getting better. A prognosis depends on the type and stage of cancer, as well as the persons age and general health.

    Bladder cancer can usually be effectively treated if it is found before it spreads outside the bladder.

    If you have bladder cancer, your doctor will talk to you about your individual situation when working out your prognosis. Every persons experience is different, and there is support available to you.

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    Amanda Diagnosed In 2021 At 37 United States

    I was having UTI symptoms when I started seeing blood in my urine I was seeking out doctors and answers. I kept getting told I had a UTI and was given antibiotics. In less than a year I went from symptoms to having a stage 4 tumor removed.

    I was misdiagnosed more than once. When I finally got a cancer diagnosis the cancer institute did not want me to start chemo because I didnt have insurance.

    What advice would you give to others who may be newly diagnosed with bladder cancer?

    Get as many second opinions as necessary and dont stop until you are heard. You are your own best advocate

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