Influential Factors

CURE, Winter 2006, Volume 5, Issue 5

Several items impact the prognosis of bladder cancer, including the type of cancer cell, the aggressiveness of the tumor (known as grade) and if the cancer has spread outside the bladder, as indicated by stage.

Transitional cell carcinoma starts in the bladder's inner lining, called the urothelium, and ranks as the most common type of bladder cancer, making up more than 90 percent of cases. The less-common squamous cell carcinoma begins in thin, flat squamous cells, possibly as a result of long-term infection or irritation, and affects about 6 percent of patients. Adenocarcinoma and small-cell carcinoma make up the remaining bladder cancers.

Grade refers to how the appearance of cancer cells differs from that of normal cells, which allows doctors to determine the aggressiveness of the tumor. While the odds for survival are good for the 70 to 80 percent of patients who are diagnosed with less aggressive low-grade bladder cancer, the odds for patients with high-grade invasive tumors are bleak.

Low-grade bladder cancer is sometimes referred to as superficial bladder cancer, but since these tumors can progress to invasive disease, some doctors have stopped using the term "superficial" in favor of specifically describing a tumor's grade and stage, the specifics of which are listed below.

Stage 0: Bladder cancer is contained within the outer layer of the bladder wall. These tumors can be easily removed while sparing the bladder. These patients have a 95 percent five-year survival rate, but stage 0 bladder cancer commonly recurs.

Stage 1: Cancer has grown beyond the bladder lining to invade the connective or supporting tissue, but the cancer has not reached the muscle of the bladder or surrounding lymph nodes. The relative five-year survival rate is 85 percent.

Stage 2: Cancer has invaded the thick muscle layer of the bladder, and the five-year survival rate drops to 55 percent.

Stage 3: Cancer has invaded the fatty tissue of the bladder and possibly nearby organs, such as the prostate, uterus or vagina. Thirty-eight percent of patients with stage 3 bladder cancer survive after five years.

Stage 4: Bladder cancer has a very poor prognosis, with 84 percent of patients dying of the disease within five years. It is characterized by metastatic cancer that has broken through the bladder wall. Metastatic cancer cells can invade the lymph nodes, bones, liver or lungs.