What to Know About Early-Stage Urothelial Carcinoma

Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is the most common type of bladder cancer. It arises in the urothelium, the layer of cells lining the inside of the bladder and other parts of the urinary tract, like the ureters and renal pelvis.

When the cancer is classified as stage 1, it means the tumor has grown through the inner lining of the bladder but has not invaded the deep muscle layer of the bladder wall. Stage 1 is considered an early-stage cancer.

The goal of treatment for stage 1 urothelial carcinoma is typically to remove the tumor completely and prevent recurrence (the cancer coming back) or progression (the cancer growing into the muscle wall or spreading).

Receiving a Diagnosis of Urothelial Carcinoma

The diagnosis of urothelial carcinoma typically involves a combination of tests and procedures.

Initial Tests

• Urinalysis and Urine Cytology: A sample of urine is checked for blood and abnormal cells.
• Cystoscopy: A doctor inserts a thin, lighted tube with a camera (cystoscope) through the urethra into the bladder to visually inspect the lining for tumors.
• Transurethral Resection of Bladder Tumor (TURBT): If a tumor is found during cystoscopy, a TURBT is performed. This procedure is both diagnostic and therapeutic. A surgeon removes the tumor through the cystoscope and sends the tissue to a lab for pathological examination. This examination determines the stage andgrade (how aggressive the cells look) of the cancer.

Imaging: How Do Doctor's Look at Urothelial Carcinoma?

• CT Scan or MRI: These imaging tests may be used to look at the rest of the urinary tract and check if the cancer has spread beyond the bladder, although this is less common with stage 1 disease.
• Intravenous Pyelogram (IVP) or CT Urogram: These studies use a contrast dye to highlight the kidneys, ureters and bladder to check for tumors in the upper urinary tract.

Keeping lines of communication open with your care team is critical. CURE spoke with Dr. Murugesan Manoharan, surgical urologic oncologist and the chief of urologic oncology surgery at Miami Cancer Institute, as well as the chairman of the Department of Urology and Abbhi Family Endowed Chair in Urologic Oncology at Baptist Health South Florida and a professor of urology at Herbert Wertheim College of Medicine, Florida International University, about four key questions patients should as their care team following a diagnosis of bladder cancer.

1. Does the facility have a multidisciplinary team and a tumor board?
2. Does the facility have access to clinical trials?
3. Does the provider have access to the latest technological advancements?
4. Is there a patient support group available?

Treatment Options

The primary treatment for stage 1 urothelial carcinoma is usually the TURBT procedure, which serves to remove the visible tumor. After TURBT, additional treatment is often needed to decrease the chance of recurrence.

Adjuvant Intravesical Therapy

Intravesical therapy involves placing liquid drugs directly into the bladder via a catheter. These treatments work directly on the bladder lining to kill remaining cancer cells and reduce the risk of recurrence.

• Chemotherapy (e.g., Mitomycin, Gemcitabine): A chemotherapy drug is instilled into the bladder, often immediately after the TURBT or in a series of weekly treatments. This is typically used for lower-risk tumors.
• Immunotherapy (Bacillus Calmette-Guérin or BCG): BCG is a weakened bacterium that stimulates the body's immune system to attack cancer cells in the bladder lining. It is often the preferred treatment for higher-grade stage 1 tumors due to its effectiveness in preventing recurrence and progression. It's usually given in a six-week induction course, sometimes followed by maintenance treatments.

Potential Side Effects

It's important to discuss the potential adverse effects of treatment with your oncologist, as managing them is key to maintaining quality of life during your cancer journey.

TURBT Side Effects

• Blood in the urine (hematuria): Common and usually resolves in a few days to weeks.
• Bladder spasms or pain: Can be managed with medication.
• Urinary tract infection (UTI): Treated with antibiotics.

Intravesical Chemotherapy Side Effects

• Bladder irritation (chemical cystitis): Symptoms like burning, frequency, and urgency when urinating.
• Bladder spasms.
• Pelvic discomfort.

Intravesical BCG Side Effects

BCG can cause a stronger immune response, leading to more pronounced side effects:

• Bladder irritation (cystitis): Often more severe than with chemotherapy.
• Flu-like symptoms: Fever, chills, fatigue and body aches, often starting hours after treatment and lasting 24 to 48 hours.
• Rarely, systemic infection: If the BCG is absorbed into the bloodstream.

What to do After a Urothelial Carcinoma Diagnosis

A diagnosis of stage 1 urothelial carcinoma can be overwhelming, but it is an early-stage cancer with excellent prognosis and treatment success rates. Your primary treatment will likely be a TURBT to remove the tumor, followed by intravesical therapy (chemotherapy or BCG) to minimize the risk of the cancer returning.

You will need close follow-up and monitoring, typically with regular cystoscopies for years, as the risk of recurrence exists. The goal of your cancer journey is curative.

Editor’s Note: This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

Reference

1. “4 Questions to Ask After a Bladder Cancer Diagnosis,” CURE; https://www.curetoday.com/view/4-questions-to-ask-after-a-bladder-cancer-diagnosis

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