What Stage Is High Grade Bladder Cancer

What Are The Factors That Affect Your Outlook On Cancer

Grading/Staging of Bladder Cancer

As for your own outlook, there are quite a few variables to consider. In addition to cancer stage and tumor grade, your age and general health may play a role. The therapies you and your doctor choose and how quickly you start treatment will also affect your outlook. Additionally, not everyone responds to a particular treatment the same way.

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.

What To Do Before And After Treatment

Talk with your doctors about whether you need to do anything to prepare for treatment and help your recovery. Some things they may suggest are to:

Stop smoking if you smoke, aim to quit before starting treatment. If you keep smoking, you may not respond as well to treatment and you may have more treatment-related side effects. Continuing to smoke also increases your risk of cancer returning.
Begin or continue an exercise program exercise will help build up your strength for treatment and recovery. It can also help you deal with side effects of treatment.
Improve diet aim to eat a balanced diet with a variety of fruit, vegetables, wholegrains and protein. Eating well can improve your strength and you may respond better to treatment.
See a physiotherapist they can teach you exercises to strengthen your pelvic floor muscles, which help control how your bladder and bowel work. These exercises are useful if you have a neobladder, a partial cystectomy, or radiation therapy.

Assessment Of Immunohistochemical Results

The TMA slides were evaluated by three independent pathologists who were blinded to the associated clinical and pathological information. The percentage of stained tumor cells in the entire area of three cores was recorded. Cutoff values for high expression of each protein were determined by ROC curve analysis as follows: E2F1 , p53 , nuclear p27 , cytoplasmic p27 , EZH2 , IMP3 , cytoplasmic survivin , nuclear survivin , TSC1/hamartin , FASN , androgen receptor , 14-3-3 , MAGEA4 , and NY-ESO-1 .

Is A Second Tur Recommended

If patients are diagnosed with high-grade T1, a second TUR is strongly recommended regardless of the presence of muscle in specimens because of the possibility of understating due to incomplete resection . It provides more accurate pathological staging information, since persistent tumor in second TUR specimens can be detected in 33%-55% of patients . Even when muscle is seen in the initial TUR specimen, muscle invasion by urothelial cancer in the second TUR specimen can be detected in up to 10% of specimens . In addition, a second TUR promotes cancer control. In a randomized controlled study, a second TUR decreased the recurrence rate compared to a single TUR . Further, residual tumor in the second TUR specimen is associated with poor prognosis. Of 92 patients with residual T1 cancer in second TURs, 75 progressed to muscle invasion within 5 years compared to 49 of 260 who had no or non-T1 tumor detected on restaging TUR . The second TUR is recommended within 2 to 6 weeks after the initial resection. Because of the high incidence of carcinoma in situ in the prostatic urethra or duct, biopsy from the prostatic urethra is recommended if tumor is located on the trigone or bladder neck .

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What Is The Most Common Type Of Bladder Cancer

The most common cell type of bladder cancer is urothelial cancer , and about 70%80% of these are nonmuscle invasive bladder cancers , while the other 20%30% are muscle invasive bladder cancers . MIBC has a poor prognosis due to invasion or metastasis to other organs. NMIBC has a high recurrence rate and progression , and thus is a great burden to patients . Moreover, T1 disease, which invades the lamina propria, and poorly differentiated high-grade disease have a poor prognosis due to a higher incidence of recurrence and progression than other NMIBC thus patients with high-grade T1 have to be carefully monitored or managed. Although bacillus Calmette-Guérin followed by transurethral resection is known as the gold standard treatment, controversies remain over whether BCG can reduce the progression rate of highgrade T1 . One third of high-grade T1 patients who receive intravesical BCG therapy progress to MIBC and are at risk of dying from bladder cancer because ineffective BCG therapy delays radical cystectomy . Nevertheless, there is no consensus about how to predict progression and manage high-grade T1 disease. Herein, this review describes how to stratify high-grade T1 disease to predict progression and how to manage it properly by reducing over or under treatment.

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.

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Grading Of A Bladder Cancer

Grading of a bladder cancer is assessing how aggressive it is in terms of howabnormal its cells look under a microscope. Those that are very abnormal growmore quickly. Grade can be divided into low or high orcan be scored from 1 to 3. Often this number has a G as a prefix toshow it represents the grade, e.g. G1, G2 or G3.

Treatment Of Stage I Bladder Cancer

Management of High-Grade T1 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:
Intravesical chemotherapy given right after surgery.
Intravesical chemotherapy given right after surgery and then regular treatments with intravesical BCG or intravesical chemotherapy.

Radical cystectomy.

A clinical trial of a new treatment.

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.

Treatment For Hg T1 Bladder Cancer With Pt0 Histology At Second Tur

TURBT followed by intravesical BCG therapy provides lower incidences of recurrence and progression than those obtained by TURBT alone . Sylvester et al. performed a meta-analysis on the efficacy of intravesical BCG therapy. They evaluated 24 trials involving a total of 4863 patients and concluded that intravesical BCG significantly reduces the risk of progression after TURBT in NMIBC patients who receive maintenance treatment. Since T1 bladder cancer is considered to be high-risk cancer regardless of the pathological findings for the second TUR specimen , various guidelines recommend full-dose intravesical BCG for 13 years except in the case of immediate cystectomy. Alternatively, mitomycin C is also recommended by the National Comprehensive Cancer Network guidelines . This is based on a meta-analysis that showed no statistically significant difference between BCG and MMC for progression and survival .

Protocol and study design of the JCOG1019 trial .

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.

This early stage of bladder cancer is most often treated with transurethral resection with fulguration followed by intravesical therapy within 24 hours.

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Treatment For Hg Pt1 Bladder Cancer With Pt2 Or More Histology At Second Tur

There is no doubt about the need to perform radical cystectomy for patients with muscle-invasive disease at the second TUR. Most of these tumors are understaged at the initial TURBT due to technical problems, and may not be large or bulky like muscle-invasive tumors that are diagnosed at the initial TURBT and/or with computed tomography or magnetic resonance imaging. The discussion on the treatment strategies for these tumors does not include whether cystectomy should be performed but whether neoadjuvant chemotherapy and/or extended lymph node dissection should be performed.

Several randomized Phase III trials and meta-analyses demonstrated the survival benefit of cisplatin-based neoadjuvant chemotherapy for patients with MIBC. However, whether neoadjuvant chemotherapy prolongs the survival of patients with T1 cancer at the initial TURBT and with muscle-invasive disease detected by a second TUR is unclear. Neoadjuvant chemotherapy offers potential advantages in tumor downstaging and eradication of micrometastases, so this therapy should be indicated for patients who have risk factors for locally advanced disease or nodal metastasis.

Bladder Cancer Metastasis To Lung Prognosis

Bladder Cancer Stages, Artwork Photograph by Peter Gardiner

Metastatic bladder cancer has a poor survival rate among those who have it . Nonetheless, some patients may live much longer than expected. If a patient is resistant to palliative chemotherapy, they may be able to extend their lives with systemic treatments.

Every year, approximately 56,000 men and 17,500 women in the United States are diagnosed with bladder cancer. The disease typically begins in cells within the bladder. Metastatic bladder cancer occurs when bladder cancer cells spread from one location to another in the body. Chemotherapy is the most commonly used treatment for bladder cancer that has spread to other parts of the body. It reduces the amount of cancer cells or slows their growth, among other things. You may benefit from radiation in order to reduce some of the symptoms and side effects that can be detrimental to your quality of life. It is the surgical removal of a large portion of the bladder during cystectomy.

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The Effect Of Age At Diagnosis With Pancreatic Cancer Metastasis To Liver

The Kaplan Meier survival curve showed significant difference in overall survival for patients diagnosed at different age groups . The overall survival time was negatively correlated with the age at diagnosis. Among the three groups, the prognosis of patients diagnosed at age less than 52 years old was the best, and of which the median survival time was 1 year. .

Kalpan Meier survival curve showing the effect of age at diagnosis with pancreatic cancer metastasis to liver.

Bladder Cancer Stages And Survival Rates

Cancer survival rates are also categorized according to the stage of the cancer when it was diagnosed. The stage of cancer generally refers to how far it has progressed, and whether it has spread to other parts of the body. For bladder cancer, the 5-year survival rate for people with:2,3

Bladder cancer in situ is around 96 percent
Localized bladder cancer is around 70 percent
Bladder cancer that has spread to the regional lymph nodes is 35 percent
Distant or metastasized bladder cancer is 5 percent

If you would like to learn more about bladder cancer statistics, consider speaking with someone on your health care team. They will be able to explain more about how these statistics apply to your cancer. Tell us about your experience in the comments below, or with the community.

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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.

Treatment of stage IV bladder cancer that has spread to other parts of the body, such as the lung, bone, or liver, may include the following:

External radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
Urinary diversion or cystectomy as palliative therapy to relieve symptoms and improve quality of life.
A clinical trial of new anticancer drugs.

What Is A 5

Treating Early Stage Bladder Cancer

A relative survival rate compares people with the same type and stage of bladder cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of bladder cancer is 90%, it means that people who have that cancer are, on average, about 90% as likely as people who dont have that cancer to live for at least 5 years after being diagnosed.

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Latest Treatment For Bladder Cancer

Intravesical therapy is a newer treatment for people who have bladder cancer. With intravesical therapy, the doctor puts a liquid medication right into your bladder rather than administering it orally or injecting it into your blood. The medication is put in through a catheter thats placed into your bladder through the urethra. The medication stays in your bladder for up to two hours, so it can affect the cells lining the inside of the bladder without having major effects on other parts of your body. Intravesical therapy is commonly used after transurethral resection of bladder tumor . Its often performed within 24 hours of the TURBT procedure. The goal is to kill any cancer cells that may be left in the bladder.

Intravesical chemotherapy is used to treat non-invasive bladder cancer. It is used for these early-stage cancers because medication given this way mostly affects the cells lining the inside of the bladder. It has little to no effect on cells elsewhere. This means any cancer cells outside of the bladder lining are not treated by intravesical chemotherapy.

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.

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Understanding Your Bladder Cancer Stage

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The staging system most often used for bladder cancer is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:

T describes how far the main tumor has grown through the bladder wall and whether it has grown into nearby tissues.
N indicates any cancer spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.
M indicates if the cancer has spread to distant sites, such as other organs, like the lungs or liver, or lymph nodes that are not near the bladder.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage.

The earliest stage cancers are called stage 0 , and then range from stages I through IV .

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

Bladder Cancer: Stage 2 High Grade

Stages of bladder cancer stock vector. Illustration of neoplasia

My husband was just diagnosed with Stage 2 high grade bladder cancer. The cancer has invaded the muscle wall but had not gone though it. He had a cat scan which showed no spreading of the disease, in particular, lymph nodes unremarkable. We made the trip to the Mayo Clinic and the urologist noticed what he thought was an enlarged lymph node. The doctor suggested a pet scan. The pet scan was conducted and shows 4 suspicious hypermetobolic lymph nodes in the abdomen. Needless to say we are scared and very confused as we though it was stage 2 and could be cured. We are going through the process of starting chemo, doing all tests, insurance approval, etc. As we understand it, at this point, surgery can not be done to remove these nodes, since they are too deep in the abdomen. We were supposed do 4 chemo cycles and then have bladder and prostate removed. We have a follow up with oncologist in two days . Since this is the weekend and we found this out on Friday afternoon, we are left with so many questions. Has anyone experienced something similar?

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