Non Muscle Invasive Bladder Cancer
In non muscle invasive bladder cancers, the cancer is only in the lining of the bladder. It has not grown into the deeper layers of the bladder wall. Non muscle invasive bladder cancer is also called superficial bladder cancer, or early bladder cancer.
Early bladder cancer usually appears as small growths, shaped like mushrooms. These grow out of the bladder lining. This is called papillary bladder cancer. Your surgeon can remove these growths and they may never come back.
But some types of early bladder cancer are more likely to come back. These include carcinoma in situ and high grade T1 tumours. T1 stands for the size of the tumour.
Carcinoma in situ
Unlike other early bladder cancers, areas of CIS are flat. They do not grow out of the bladder wall. In CIS the cancer cells look very abnormal and are likely to grow quickly. This is called high grade. It is more likely to come back than other types of early bladder cancer.
High grade T1 tumours
T1 tumours are early cancers that have grown from the bladder lining into a layer underneath, called the lamina propria. High grade T1 tumours are early cancers, but they can grow very quickly.
Risk groups
Doctors divide early bladder cancer into 3 risk groups. These risk groups describe how likely it is that your cancer will spread further or come back after treatment. Your risk group depends on several factors including the size of the tumour , what the tissue looks like under the microscope and type of bladder tumour.
Understanding Bladder Cancer Staging
The stages of bladder cancer range from 0 to 4. Some of the stages also include different categories within the stage itself.
To determine the stage of your cancer, your medical team will determine how far your cancer has grown into the wall of the bladder, if it has grown into nearby organs, and if it has spread to lymph nodes and distant organs. The higher the stage of bladder cancer, the more advanced and widespread the cancer is.
To better understand bladder cancer stages, its helpful to know more about the bladder itself. The bladder has four layers. The innermost layer is called the urothelium, or transitional epithelium. This is where almost all bladder cancers start. The next layer contains connective tissue, blood vessels, and nerves. Next is a layer of muscle, and finally, the outer layer is made up of fatty connective tissue.
To determine the stage of bladder cancer, your medical team will order several tests, including:
Bladder Cancer Doctor Discussion Guide
Integration And Label Transfer Of Single
Our normal bladder epithelial cell scRNA-seq data was mapped to a scRNA-Seq dataset from HRA000212 including eight human BCa samples . Using the method of integrating multiple single-cell datasets in Seurat v3, shared cell states that exist in different datasets were identified. Anchors were first identified using the integrationanchor function, which accepts a list of Seurat objects as input. The TransferData function was then used to classify the cells in the query data set according to the reference data. TransferData returns a matrix with a prediction id and prediction score .
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What Is The M1 Category
The Metastasis category describes whether the cancer has spread to organs and/or lymph nodes in other parts of the body that are more distant from the bladder. The category M1 means that the cancer has spread to distant parts of the body and the category M0 means that the cancer has not spread to distant parts of the body.
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.
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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.
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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.
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Muscle-invasive. Muscle-invasive bladder cancer has grown into the muscle of the bladder wall 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 potential 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.
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Categories Of Bladder Cancer
Bladder cancers fall into five broad categories based on their grade andstage – a full explanation of these terms can be found below:
- Low risk non-muscle invasive bladder cancerThese are small , single low grade Grade 1 or Grade 2) bladdercancers that haven’t grown beyond the inner layer of the bladder. They are usuallydescribed as papillary and are called pTa – where the p indicatesthat this has been found out by biopsy.
- Intermediate risk non-muscle invasive bladder cancerThese are larger or multiple low grade pTa bladder cancers.Small, single low grade pT1 tumours are also in this category where T1indicates that the cancer has grown a little further into the bladder wall. Also if low risk tumours keep growing backthey fall into this category.
- High risk non-muscle invasive bladder cancerThese are Grade 3 pTa or pT1 bladder cancers. All larger ormultiple T1 tumours are also included. Carcinomain Situ is also in this category.
- Muscle invasive bladder cancerThese are bladder cancers which are pT2 or pT3 which indicates that the cancerhas grown further into the bladder wall and is found in the inner muscle layer.
- Advanced bladder cancerThese are bladder cancers which are pT4 which indicates that it has grownthrough the bladder wall or have spread to nearby lymph nodes to varying degrees- referred to as N1, N2 or N3) or to other sites in the body referred to as M1.
Tnm Staging System For Bladder Cancer
The TNM staging system uses letters and numbers to describe the bladder cancer.
- T is how far the tumour has grown into the bladder, and how far it has spread into the surrounding tissues.
- N is whether the tumour has spread to the nearby lymph nodes.
- M is whether the tumour has spread to another part of the body .
Non-muscle-invasive bladder cancer means the cancer cells are only in the inner lining of the bladder. This means non-muscle-invasive bladder cancers are always N0 and M0.
Non-muscle-invasive bladder cancer can be staged as CIS, Ta or T1.
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Cystectomy Cystoprostatectomy And Pelvic Exenteration Specimens
Processing of these specimens may be summarized in three steps: orientation of the specimen and identification of relevant anatomic structures , fixation of the specimen and dissection of the specimen. Peritoneum covering the surface of the bladder is a reliable anatomic landmark. In both male and female patients, the peritoneum descends further along the posterior wall of the bladder than it does along the anterior wall. Other pelvic organs, if present, may also be used to orient the specimen. In the male, the bladder adjoins the rectum and seminal vesicles posteriorly, the prostate inferiorly, and the pubis and peritoneum anteriorly. In the female, the vagina is located posteriorly, and the uterus is located superiorly. Once the specimen is oriented, both ureters and, when present, the vasa deferentia should be identified. Location and dissection of the ureters is easier after fixation. The outer dimensions of the urinary bladder, as well as the length and diameter of ureters, should be recorded. The external surface of the bladder should be inked.
The minimum number of sections to be taken are as follows: tumor bladder neck , trigone , anterior wall , posterior wall , lateral walls , dome , ureteral orifices , margins , any abnormal appearing bladder mucosa and any perivesical lymph nodes .
Figure 18
T Categories For Bladder Cancer
The T category describes how far the main tumor has grown into the wall of the bladder .
The wall of the bladder has 4 main layers.
- The innermost lining is called the urothelium or transitional epithelium.
- Beneath the urothelium is a thin layer of connective tissue, blood vessels, and nerves.
- Next is a thick layer of muscle.
- Outside of this muscle, a layer of fatty connective tissue separates the bladder from other nearby organs.
Nearly all bladder cancers start in the lining or urothelium. As the cancer grows into or through the other layers in the bladder, it becomes more advanced .
The T categories are described in the table above, except for:
TX: Main tumor cannot be assessed due to lack of information
T0: No evidence of a primary tumor
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Small Cell Carcinoma Of The Bladder
This aggressive form of the disease begins in small nerve-like cells in the bladder called neuroendocrine cells. Small cell carcinoma makes up about 1 percent of bladder cancers. It is often detected at an advanced stage, after it has spread to other parts of the body. It usually requires a combination of treatments, including chemotherapy, surgery, and radiation therapy.
There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- 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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Testing The Difference In Tumor Stage Of Each Cell Lineage By The Rank
Combining the data of the proportion of each lineage in bladder cancer obtained by the above deconvolution and the data of TCGA clinical patient cancer staging , we obtained the content of each cell type in T and N stages. The statistical method of difference test can be used to find the correlation between cell types and cancer staging. We used the violin plot to visualize the distribution of cell content in different stages and used the rank-sum test to obtain the difference p value. In the calculation process, we divided T1â2 into T_low, T3â4 into T_high, and the N stage into N0 and above.
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
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Treatment Of Bladder Cancer By Stage
Most of the time, treatment of bladder cancer is based on the tumors clinical stage when it’s first diagnosed. This includes how deep it’s thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing , and a persons overall health and preferences, also affect treatment options.
Metastatic And Recurrent Cancers
Metastases require chemotherapy, generally cisplatin based, which is frequently effective but rarely curative unless metastases are confined to lymph nodes. This can be followed by maintenance immunotherapy with avelumab. Combination chemotherapy may prolong life in patients with metastatic disease. For patients who are cisplatin ineligible or have progressed after receiving cisplatin-based regimens, newer immunotherapies using PD-1 and PD-L1 inhibitors are available, such as pembrolizumab and atezolizumab. The first targeted therapy, erdafitinib, is now available for use in patients with FGFR3 and FGFR2 mutations who have failed treatment with chemotherapy.
Treatment of recurrent cancer depends on clinical stage and site of recurrence and previous treatment. Recurrence after transurethral resection of superficial tumors is usually treated with a 2nd resection or fulguration. Early cystectomy is recommended for recurrent high-grade superficial bladder cancers.
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What Causes Bladder Cancer And Am I At Risk
Each year, about 83,730 new cases of bladder cancer will be diagnosed in the United States. It affects more men than women and the average age at diagnosis is 73.
Cigarette smoking is the biggest risk factor for bladder cancer. About half of all bladder cancers are caused by cigarette smoking. Other risk factors for developing bladder cancer include: family history, occupational exposure to chemicals , previous cancer treatment with cyclophosphamide, ifosfamide, or pelvic radiation, the medication pioglitazone, exposure to arsenic , aristolochic , bladder infections caused by schistosoma haematobium, not drinking enough fluids, a genetic condition called Lynch Syndrome, a mutation of the retinoblastoma gene or the PTEN gene. and neurogenic bladder and the overuse of indwelling catheters.
Prognosis And Survival For Bladder Cancer
If you have bladder cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for bladder cancer.
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Occurrence In The United States
The American Cancer Society estimates that 81,180 new cases of bladder cancer will be diagnosed in the United States in 2022 and that 17,100 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 4 times more common in men than in women. 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 2022, with 12,120 deaths in men versus 4980 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.
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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What Is Bladder Cancer
The bladder, a hollow organ in the lower part of the abdomen, serves as a reservoir for urine until it is discharged out of the body through the urethra.
There are different types of bladder cancer. The cancer cell type can be transitional cell carcinoma, squamous cell carcinoma or adenocarcinomaeach named for the types of cells that line the wall of the bladder where the cancer originates.
- Most bladder cancers start from the transitional cells, which occupy the innermost lining of the bladder wall. The cancers, which originate in these cells lining the bladder can, in some instances, invade into the deeper layers of the bladder , the thick muscle layer of the bladder, or through the bladder wall into the fatty tissues that surround the bladder.
- Squamous cells are thin flat cells that line the urethra and can form in the bladder after long bouts of bladder inflammation or irritation. Squamous cell carcinoma makes up about 5 percent of bladder cancers.
- Adenocarcinoma is a very rare type of bladder cancer that begins in glandular cells in the lining of the bladder. Only 1 percent to 2 percent of bladder cancers are adenocarcinoma.