Like many other types of cancer, bladder cancer is a complex diagnosis with several subtypes. The urologist who diagnosed you will most likely have information from the tissue samples removed during a surgical procedure to tell you more about the type and grade of bladder cancer. After a diagnosis is confirmed, you’ll also see an oncologist who will most likely stage the cancer. Some other tests may be needed to do this.

Staging tells the cancer care team how far the cancer has grown into the bladder muscle wall, and whether it’s affected lymph nodes or other areas of the body.

All of the information gathered by both the urologist and oncologist is reviewed, and a treatment plan is developed specific to each patient’s needs.

Understanding Bladder Cancer Types

When doctors talk about the type of bladder cancer, they’re referring to what the cancer cells look like under a microscope. Not all cancer cells behave in the same manner — some grow slowly, while others grow more aggressively. Identifying your specific type of bladder cancer gives your oncologist valuable insight into how your cancer may act and what treatments you’ll benefit from the most.

Urothelial carcinoma, also known as transitional cell carcinoma, accounts for the majority of bladder cancer cases. This type of cancer starts in the inner lining of the bladder, where urine collects. Fortunately, there are several effective treatment options for urothelial carcinoma, depending on the stage and grade of the tumor.

Less Common Types of Bladder Cancer

Though less common, other types of bladder cancer can develop. These include:

• Squamous cell carcinoma
• Adenocarcinoma
• Small cell carcinoma

These rarer types arise from different cells within the bladder and behave differently from urothelial carcinoma. Because of this, a different treatment approach might be necessary. The more your cancer care team understands your specific type of bladder cancer, the better they can tailor your treatment plan to your diagnosis.

Bladder Cancer Tumor Grade

The grade of the tumor is also important when evaluating treatment options. The grade reflects how differentiated the cancer cells appear under a microscope, indicating how the cancer might behave over time.

Tumors are classified as low-grade or high-grade:

• Low-grade cancers tend to grow slowly and are less likely to spread quickly
• High-grade cancers appear more abnormal and are more likely to grow or spread faster

It’s important to understand that grading is not the same as staging, which describes how far the cancer has spread beyond its original location. However, both are essential components in developing a treatment plan.

What Bladder Cancer Stage Means

Staging bladder cancer involves determining how far the cancer has progressed. Specifically, the stage tells how deeply the cancer has grown into the bladder and whether it has spread to areas beyond it.

Your oncologist will determine the stage of your bladder cancer through pathology reports, blood tests, and imaging results. The information gathered from these assessments is then categorized into three broad stages:

Early-Stage (Non-Muscle-Invasive) Bladder Cancer

In early-stage bladder cancer, the tumor is confined to the inner lining of the bladder and has not grown into the muscle layer. This type is often referred to as non-muscle-invasive bladder cancer.

Typically, treatment for patients with this stage of bladder cancer involves a transurethral resection (TURBT) to remove the tumor, followed by intravesical therapy, where chemotherapy is administered directly into the bladder to reduce the risk of recurrence.

The good news is that early-stage bladder cancers are often effectively treated. It can, however, recur. That means it’s very important you go to follow-up appointments with your care team to be monitored. The earlier a recurrence is detected, the easier it is to manage.

Muscle-Invasive Bladder Cancer

When the cancer has penetrated the muscle layer of the bladder wall, it is referred to as muscle-invasive. Because this stage of bladder cancer is more likely to spread, treatment is usually more aggressive.

In many cases, a TURBT is performed first to determine the tumor’s stage, followed by a radical cystectomy to remove part or all of the bladder. Your surgeon will give you a way for urine to be removed from the body, such as an external pouch or an internal, continent system called an Indiana Pouch.

A combination of chemotherapy drugs is usually the next step. It can be given before surgery, after surgery, or both to ensure cancer cells in the bladder, lymph nodes, and any other area of the body are destroyed.

Radiation therapy can be used, but may not be helpful if the cancer has grown in a larger area around the bladder or impacted some lymph nodes.

Thanks to clinical research studies, immunotherapy after chemotherapy is now an option for muscle-invasive bladder cancer patients who show signs of circulating tumor DNA in their blood. This uses the body’s immune system to attack the cancer cells.

Advanced or Metastatic Bladder Cancer

Advanced bladder cancer indicates that the cancer has spread outside the bladder and is affecting nearby lymph nodes or distant organs. In such cases, treatment generally involves medications such as chemotherapy or immunotherapy that travel through the bloodstream to target cancer cells throughout the body. Participating in a clinical trial to explore newer treatment options may also be suggested.

Learn more about bladder cancer staging and grading.

The Differences Between Non-muscle Invasive and Muscle-invasive Bladder Cancer Treatment

Your specific bladder cancer diagnosis, including type, grade, and stage, plays a crucial role in guiding your care team's treatment decisions.

For early-stage bladder cancers, treatment is often possible without removing the bladder, allowing patients to maintain normal bladder function. However, cancers that have invaded the muscle layer of the bladder will likely require stronger treatments to remove the tumor and reduce the risk of it returning later on.

For cancers that have spread beyond the bladder, systemic therapies that reach cancer cells throughout the entire body are usually recommended. Depending on your diagnosis, this could include chemotherapy, targeted therapy, immunotherapy, or a combination of these medicines.

It’s important to remember that there’s no one-size-fits-all approach to treating bladder cancer. At Rocky Mountain Cancer Centers, your care team uses the specifics of your diagnosis to guide treatment recommendations. They will also review options for clinical research studies that may suit your specific needs.

Comprehensive Expert Bladder Cancer Care in Colorado

If you were recently diagnosed with bladder cancer, the genitourinary oncology team at RMCC is here for you. We’ll take time to answer the questions about your diagnosis so you can move forward with confidence and make informed decisions about your care. Request an appointment at one of our convenient locations in Colorado, including the Denver area, Boulder, Colorado Springs, and Pueblo.