What Is A Urothelial Carcinoma
Around 90% of people who are diagnosed with bladder cancer in the United States have the type called urothelial carcinoma.2,3 It is called urothelial because the cancer cells start out by developing in the lining of the bladder walls, in a layer of cells called the urothelium. Another name for this type of bladder cancer is transitional cell carcinoma.
Muscle Invasive Urothelial Carcinoma
Muscle invasive urothelial carcinoma tumors have spread into or through the muscle layer of the bladder wall.
- T2 tumors have spread into the muscle layer of the bladder wall.
- T3 tumors have spread through the muscle layer and into the fatty tissue surrounding the bladder.
- T4 tumors have spread to nearby pelvic organs, the pelvic wall, or the abdominal wall.
As well as assigning a T category, the commonly used TNM clinical staging system also assigns urothelial carcinoma to an N category and an M category . For further information regarding bladder cancer classification, see Bladder Cancer Stages.
Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
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Signs And Symptoms Of Bladder Cancer
Sometimes bladder cancer doesnt have many symptoms. Signs or symptoms can include:
- blood in your urine
- pain or burning when passing urine
- not being able to pass urine when you need to.
Not everyone with these symptoms has bladder cancer. If you have any of these symptoms or are worried, always see your doctor.
Bladder Cancer Risk Factors
Anything that increases your chance of getting bladder cancer is a risk factor. These include:
Smoking tobacco: This is the greatest risk factor for bladder cancer that individuals can control. Smokers, including pipe and cigar smokers, are two- to three-times more likely than nonsmokers to get bladder cancer. Chemicals in tobacco smoke are absorbed into the blood, and then they pass through the kidneys and collect in the urine. These chemicals can damage the inside of the bladder and increase your chances of getting bladder cancer.
Age: The chance of developing bladder cancer increases with age. It is uncommon in people under 40. Most diagnoses are in people age 65 or older.
Race: Bladder cancer occurs twice as often in Caucasians as it does in African Americans and Hispanics. Asians have the lowest rate of developing the disease.
Gender: Men are up to four times as likely as women to get bladder cancer.
Personal history of bladder cancer: Bladder cancer has a 50% to 80% chance of returning after treatment, either as a recurrence of the first cancer or as a second individual disease.
Exposure to chemicals: Historical studies have shown that people who work around certain chemicals are more likely to get bladder cancer. These include:
- People who work in the rubber, chemical and leather industries
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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.
Side Effects Of Treatment For Bladder Cancer
All cancer treatments can have side effects. Your treatment team will discuss these with you before you start treatment. Talk to your doctor or nurse about any side effects you are experiencing. Some side effects can be upsetting and difficult, but there is help if you need it. Call Cancer Council or email to speak with a caring cancer nurse for support.
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Treatment For Stage 4 Bladder Cancer
Treatment for stage 4 bladder cancer may include:
- chemotherapy without surgery to relieve symptoms and extend life
- radical cystectomy and removal of the surrounding lymph nodes, followed by a surgery to create a new way for urine to exit the body
- chemotherapy, radiation therapy, and immunotherapy after surgery to kill remaining cancer cells or to relieve symptoms and extend life
- clinical trial drugs
, the five-year survival rates by stage are the following:
- The five-year survival rate for people with stage 0 bladder cancer is around 98 percent.
- The five-year survival rate for people with stage 1 bladder cancer is around 88 percent.
- The five-year survival rate for people with stage 2 bladder cancer is around 63 percent.
- The five-year survival rate for people with stage 3 bladder cancer is around 46 percent.
- The five-year survival rate for people with stage 4 bladder cancer is around 15 percent.
There are treatments available for all stages. Also, survival rates dont always tell the whole story and cant predict your future. Speak with your doctor about any questions or concerns you may have regarding your diagnosis and treatment.
Because doctors dont yet know what causes bladder cancer, it may not be preventable in all cases. The following factors and behaviors can reduce your risk of getting bladder cancer:
- not smoking
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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Prognosis In Squamous Cell Carcinoma
Tumor stage, lymph node involvement, and tumor grade have been shown to be of independent prognostic value in SCC. However, pathologic stage is the most important prognostic factor. In one relatively large series of 154 cases, the overall 5-year survival rate was 56% for pT1 and 68% for pT2 tumors. However, the 5-year survival rate for pT3 and pT4 tumors was only 19%.
Several studies have demonstrated grading to be a significant morphologic parameter in SCC. In one series, 5-year survival rates for grade 1, 2, and 3 SCC was 62%, 52%, and 35%, respectively. In the same study of patients undergoing cystectomy, the investigators suggested that a higher number of newly formed blood vessels predicts unfavorable disease outcome.
In SCC, the survival rate appears to be better with radical surgery than with radiation therapy and/or chemotherapy. In locally advanced tumors, however, neoadjuvant radiation improves the outcome. Sex and age have not been prognostically significant in SCC.
Pathology: Examining Tissue For Signs Of Cancer
When a polyp or other area of suspicious tissue is seen during a cancer screening test, the doctor may take a tissue sample called a biopsy right away, depending on the bodily location being examined, or at a later date, if doing so requires a second procedure. A pathologist then examines the tissue under a microscope to look for cancerous cells.
To better visualize the various parts of the tissue, the pathologist often stains it, sometimes with multiple dyes.
The pathologist looks for abnormalities in the shape and size of cells, shape and size of cell nuclei, and distribution of the cells in the tissue, indicating cancer.
Once the pathologist has confirmed that a biopsy shows cancer, other lab tests may be done to help classify the cancer, which can in turn help to guide treatment.
While much of the work of examining tissue samples is still done by individuals looking through microscopes, advances in automated detection and classification of cancer cells promise faster diagnosis and treatment.
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Squamous Cell Carcinoma Of The Bladder
Squamous cell carcinoma is the second most common type of bladder cancer. It accounts for about 5 percent of bladder cancers in North America and Europe. This cancer begins in the thin, flat squamous cells that may form in the bladder after chronic inflammation and infection. Squamous cell carcinoma is most often found in parts of the world where a parasitic infection called schistosomiasis is widespread, such as the Middle East.
How To Prevent Bladder Cancer
The study on bladder cancer is still going on. Moreover, the doctors do not know its causes so you can try out some of the common preventing ideas by professionals. You should avoid smoking as it can kill immunity and decreases the life of a person. Also, you should drink plenty of water every day so the system of your body works properly.
If you feel the symptoms of even slight pain, you should never take it lightly. Bladder cancer can be deadly for you and it can spread quickly if not taken care of.
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Occurrence In The United States
The American Cancer Society estimates that 83,730 new cases of bladder cancer will be diagnosed in the United States in 2021 and that 17,200 people will die of the disease. The incidence of bladder cancer increases with age, with the median age at diagnosis being 73 years bladder cancer is rarely diagnosed before age 40 years.
Bladder cancer is about 3 times more common in men than in women. Over the past 2 decades, however, the rate of bladder cancer has been stable in men but has increased in women by 0.2% annually. The male predominance in bladder cancer in the United States reflects the prevalence of transitional cell carcinoma . With small cell carcinomain contrast to TCCthe male-to-female incidence ratio is 1:2.
Bladder cancer is the fourth most common cancer in men in the United States, after prostate, lung, and colorectal cancer, but it is not among the top 10 cancers in women. Accordingly, more men than women are expected to die of bladder cancer in 2021, with 12,260 deaths in men versus 4940 in women. Nevertheless, women generally have a worse prognosis than men.
The incidence of bladder cancer is twice as high in white men as in black men in the United States. However, blacks have a worse prognosis than whites.
Limited data indicate that small cell carcinoma of the urinary bladder probably has the same epidemiologic characteristics as urothelial carcinoma. Patients are more likely to be male and older than 50 years.
What Is Meant By Staging And Grading A Tumor
If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body. Grade refers to what the cancer cells look like, and how many cells are multiplying. The higher the grade, the more uneven the cells are and the more cells are multiplying. Knowing the grade can help your doctor predict how fast the cancer will grow and spread.
Urologists typically send a sample of the cancer tissue to a pathologist, a doctor who specializes in examining tissue to determine the stage and grade of the cancer. The pathologist writes a report with a diagnosis, and then sends it to your urologist.
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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.
Papillary Or Flat Tumors
Papillary tumors grow out from the inner lining toward the hollow center of the bladder, in slim finger-shaped growths. These are often non-invasive, because they grow outward from the bladder lining rather than inward deeper into the bladder walls. One type of slow growing, non-invasive papillary bladder cancer is called papillary urothelial neoplasm of low malignant potential .
Flat bladder tumors do not grow into the hollow part of bladder, but grows in a flat shape instead. If a flat tumor has not grown outside of the urothelium layer of cells, then it is non-invasive. If it has grown deeper into the bladder wall, then it is called invasive.
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Other Ways Of Describing Bladder Cancer
In addition to its cell type, bladder cancer may be described as noninvasive, non-muscle-invasive, or muscle-invasive.
Noninvasive. Noninvasive bladder cancer includes noninvasive papillary carcinoma and carcinoma in situ . Noninvasive papillary carcinoma is a growth found on a small section of tissue that is easily removed. This is called stage Ta. CIS is cancer that is found only on or near the surface of the bladder, which is called stage Tis. See Stages and Grades for more information.
Non-muscle-invasive. Non-muscle-invasive bladder cancer typically has only grown into the lamina propria and not into muscle, also called stage I. Non-muscle-invasive cancer may also be called superficial cancer, although this term is being used less often because it may incorrectly suggest that the cancer is not serious.
Muscle-invasive. Muscle-invasive bladder cancer has grown into the bladder’s wall muscle and sometimes into the fatty layers or surrounding tissues or organs outside the bladder.
It is important to note that non-muscle-invasive bladder cancer has the possibility of spreading into the bladder muscle or to other parts of the body. Additionally, all cell types of bladder cancer can spread beyond the bladder to other areas of the body through a process known as metastasis.
Treating A Benign Bladder Tumor
Treatment for your tumor will depend on what type of tumor you have. First, your doctor may diagnose the tumor via biopsy or endoscopy. An endoscopy will provide a visual look, while a biopsy will provide a tissue sample of the tumor.
After diagnosing the tumor, your doctor will develop a treatment plan that best suits your condition.
If the tumor is positioned so the risk of surgery damaging blood vessels, nerves, and the surrounding area is relatively low, theyll most likely recommend removing the tumor.
If the tumor doesnt pose a direct threat, wont likely grow, and isnt causing any issues currently, your doctor may suggest monitoring the tumor.
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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:
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 found in the urinary tract. Urothelial carcinoma is sometimes also called transitional cell carcinoma or TCC.
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.
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 sarcoma 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.
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.
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Smoking Can Affect The Risk Of Bladder Cancer
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer.
Risk factors for bladder cancer include the following:
- Using tobacco, especially smoking cigarettes.
- Having a family history of bladder cancer.
- Having certain changes in the genes that are linked to bladder cancer.
- Being exposed to paints, dyes, metals, or petroleum products in the workplace.
- Past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide.
- Taking Aristolochia fangchi, a Chinese herb.
- Drinking water from a well that has high levels of arsenic.
- Drinking water that has been treated with chlorine.
- Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
- Using urinarycatheters for a long time.
Older age is a risk factor for most cancers. The chance of getting cancer increases as you get older.