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the lower-stage bladder cancers, the individual will feel
fine and typically will have no symptoms. Sometimes
they will have frequency of urination, but many patients
disregard what they interpret as just bothersome
When faced symptoms. Thus, when faced with the shock of being
with the shock diagnosed with bladder cancer, common reactions are
of being fear, anger, confusion, and depression. It is not unusual
diagnosed to retreat initially from life as you absorb the reality of
with bladder the situation and begin to gather information and start
cancer, the decision-making process. Many patients will have
common feelings of failure or guilt, withdraw socially, feel that
reactions are they are being punished, lose interest in activities that
fear, anger, used to bring them pleasure, or find that they are cry-
confusion, and ing a lot. Some will have overwhelming feelings of
depression. doom or helplessness and may even think about sui-
cide. These can all be signs of serious depression, and
you should discuss this with your doctor immediately.
Sometimes, when faced with such potentially over-
whelming situations, you may need some assistance to
help you gain control of your life again and make the
decisions that you will need to make regarding your
treatment. Never be afraid to ask for help.
29. What does the tumor grade mean?
The pathologist grades a tumor based on how the cells
Low grade
look under the microscope. The tumor cells can appear
Cancer that does not
close to normal (low grade) or more aggressive and
appear aggressive.
angry (high grade). As you might expect, low-grade
High grade
tumors tend to have a better prognosis than high-grade
Very advanced cancer
tumors. Most pathologists grade tumor biopsies as
cells.
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I, II, and III instead of high and low. The grade of the
tumor allows us to predict who will go on to develop
invasive tumors and who will not; 6% of grade I
tumors, 52% of grade II tumors, and 82% of grade III
tumors will become invasive.
It is harder to define three different grades for a cytol-
ogy specimen, and thus most urine cytologies are sim-
ply reported as high grade or low grade.
30. What are the different stages of
bladder cancer?
In addition to determining the grade of the tumor, the
pathologist will determine the stage of the tumor
(Figure 3), which refers to the extent of the cancer and
therefore the chances that it has spread beyond the
bladder. The pathologist looks at how deep the tumor
Perivesical fat
Muscularis propria
Lamia propria
Urothelium layer
Tis
Ta
T1
T2
T3
T4
Figure 3 Various stages of bladder cancer.
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invades into the bladder wall. If the cancerous cells are
only found in the first layer of the bladder wall (the
urothelium), then the cancer is called superficial. If the
cells penetrate beyond this into the deeper muscle of
the bladder wall, then it is called invasive.
Tumor describes the primary tumor.
" TX: The tumor cannot be assessed.
" T0: No evidence of tumor exists.
Noninvasive " Ta: The tumor is noninvasive papillary carcinoma that
Not requiring any
will not spread.
incision or the inser-
" Tis: The tumor is confined to the lining of bladder.
tion of an instrument
" T1: The tumor has spread to the tissue under the
or substance into the
body.
bladder lining.
" T2: The tumor has spread to the bladder muscle.
" T3: The tumor has spread to the tissue on the out-
side of the bladder.
" T4: The tumor has spread to prostate, uterus, vagina,
pelvic wall, or abdominal wall.
Nodes describe whether cancer has spread into the
lymph nodes in the pelvis.
" NX: The lymph nodes in the pelvis cannot be
examined.
" N0: No bladder cancer is found in lymph nodes.
" N1: Bladder cancer is found in one lymph node, 2 cm
(0.8 in.) or less in dimension.
" N2: Bladder cancer is found in one or more lymph
nodes, none more than 5 cm (2 in.) in dimension.
" N3: Bladder cancer is found in one or more lymph
Metastasis
nodes, more than 5 cm (2 in.) in dimension.
The spread of disease
(cancer cells) from one
organ or part to
Metastasis describes the extent of cancer spread out-
another not directly
connected with it. side of the pelvic region.
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" MX: The spread of cancer to other organs cannot be
evaluated.
" M0: No evidence of bladder cancer exists elsewhere
in the body.
" M1: Bladder cancer cells are found somewhere else
in the body.
The stage is very important in determining the treat-
ment that you will receive. There is a good barrier
between the urothelium and the muscle of the bladder
wall. If the tumor is kept within this barrier, the tumor
Transurethral
can usually be completely removed with a transurethral
resection of blad-
resection of bladder tumor (TURBT) (Question 38).
der tumor (TURBT)
If the tumor has become more aggressive, it may figure
Removal of a bladder
out how to pass through this barrier. When the tumor
tumor(s) through a
specialized instru-
has gotten through the protective layer, it becomes
ment, a resectoscope,
much more likely to spread outside of the bladder to
that is passed
other organs or lymph nodes. Once the tumor has got- through the penis
into the bladder.
ten through the urothelium, simple scraping of the
tumor is not likely to get all of the tumor out, and further
therapy will be necessary either surgery, chemotherapy,
Staging
or radiation. The option that you and your doctor choose
The process of deter-
will depend on the extent of spread of the tumor and
mining the extent of
disease. It is helpful
your overall health status.
in determining the
most appropriate
Over the years, several different systems have been used treatment. It often
involves physical
to stage cancers. In an effort to ease confusion between
examination, blood
different systems, doctors around the world met and
testing, and X-ray
studies.
decided to create a new staging system that would be
relevant for all different types of cancer. This system is
TNM
called TNM. The letters stand for Tumor size, lymph
A specialized cancer-
Node status, and the extent of Metastases. staging system that
assesses the extent of
cancer in the organ
It took me about 6 months to finally figure out what this
the cancer developed
in, the lymph nodes,
was. All doctor said was, You have a T2N0 tumor. I m
and surrounding/
thinking, Well, is that good? I wrote it down on a napkin
distant tissues/organs.
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that I had and kept it in my purse. A few months later, I
showed it to my son, who looked it up for me. As it turns
out, it is pretty good, as much as any of this is good. (S. R.,
68 years old)
31. What are upper tract studies, and why
do I need them?
Upper tract studies are evaluations that your doctor
does of your kidneys and ureters. The lining of the
bladder is the urothelium. The same urothelium also
lines the ureters and the inside of the kidneys. The
kidneys and the ureters are then also potential loca-
tions of transitional cell cancer. The study that your
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zanotowane.pldoc.pisz.plpdf.pisz.plcs-sysunia.htw.pl
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