Bladder Transitional Cell Carcinoma Stage I

Stage I bladder transitional cell carcinoma is an early form of bladder cancer where the disease has begun to grow into the connective tissue beneath the bladder lining but has not yet reached the muscle wall. Caught at this stage, the cancer is treatable, though it has a tendency to return.

Table of contents

• What is bladder transitional cell carcinoma stage I?
• Parts of the body affected
• Symptoms
• Causes and risk factors
• How doctors diagnose this condition
• Treatment approaches
• Outlook and follow-up care

What is bladder transitional cell carcinoma stage I?

Transitional cell carcinoma, also called urothelial carcinoma, is cancer that starts in special cells that line the inside of the bladder. These cells are called transitional cells or urothelial cells because they can change shape. They stretch when the bladder fills with urine and shrink when it empties.^[1]

Transitional cell carcinoma accounts for about 90% of all bladder cancers in the United States.^[1] When doctors talk about stage I bladder cancer, they mean the cancer has started to grow into the layer of connective tissue beneath the bladder lining, called the lamina propria.^[5] This stage is also known as T1 in the medical staging system.^[3]

Stage I bladder cancer is considered non-muscle-invasive, which means the cancer has not yet grown into the muscle layer of the bladder wall.^[8] This is an important distinction because cancers that reach the muscle behave differently and require different treatments.

Urothelial carcinoma, T1 bladder cancer, non-muscle-invasive bladder cancer

Parts of the body affected

• Bladder
• Bladder lining (urothelium)
• Lamina propria (connective tissue layer beneath the bladder lining)

The bladder is a hollow, balloon-shaped organ in the lower part of the abdomen that stores urine. It has a muscular wall that allows it to expand and contract. The bladder works together with the kidneys to remove waste from the body. Tiny tubes called ureters carry urine from each kidney to the bladder, where it is stored until it leaves the body through a tube called the urethra.^[11]

Symptoms

Symptoms of bladder transitional cell carcinoma may not appear right away. Blood in the urine, called hematuria, is usually the first noticeable sign. You should contact a healthcare provider if you notice bloody urine or other symptoms.^[1]

Common symptoms include:^[1][4]

• Blood in the urine
• Frequent urination
• Painful urination
• Persistent low back pain
• Fatigue
• Unexplained weight loss

Causes and risk factors

Medical researchers are not sure exactly what causes transitional cell carcinoma. The disease involves changes in healthy transitional cells that cause them to become cancer cells. These cancer cells can form tumors and, without treatment, can spread.^[1]

Several factors can increase your risk of developing this type of bladder cancer:^[1]

• Smoking cigarettes: Smoking is thought to cause about half of all bladder cancers and significantly increases risk
• Sex: Men are four times more likely to get bladder cancer than women
• Age: Most people diagnosed are over age 65
• Exposure to certain chemicals: People who work with chemicals used in dyes, rubber, leather, paint, textiles, and hairdressing supplies may have increased risk
• Personal history of bladder cancer: Having had bladder cancer before increases the risk of developing cancer in other parts of the urinary system

You might reduce your risk of developing bladder cancer by not smoking and avoiding exposure to harmful chemicals.^[1]

How doctors diagnose this condition

Healthcare providers use several tests to diagnose bladder cancer and determine its stage. These tests help doctors see inside the bladder and examine tissue samples.^[1]

Urine tests: Your provider will examine a urine sample through a test called urinalysis. They may also check for cancer cells in your urine.^[1]

Imaging tests: You may need a CT scan (computed tomography), MRI (magnetic resonance imaging), ultrasound, or other imaging tests so your provider can see tumors inside your body. An intravenous pyelogram uses a contrast dye that makes blockages in your urinary system stand out on an X-ray.^[1]

Cystoscopy: This is a key test where your provider uses a scope with a light and lens to look inside your bladder. During this procedure, they can take tissue samples for testing, which is called a biopsy.^[1] The biopsy allows doctors to examine the cells under a microscope and determine the stage and grade of the cancer.

For stage I bladder cancer, accurate diagnosis of how deeply the cancer has grown into the lamina propria is essential. Early diagnosis and careful examination of tissue samples are critical for determining the most appropriate treatment.^[3]

Treatment approaches

The treatment of stage I bladder cancer focuses on removing the tumor and reducing the risk that the cancer will come back. The main treatment approach combines surgery with additional therapy given directly into the bladder.^[8]

Surgery: The first treatment is usually a surgical procedure called transurethral resection (TUR) with fulguration. During this procedure, the surgeon removes the tumor through the urethra using special instruments. Sometimes surgery needs to be repeated if the first procedure did not remove enough of the tumor or did not include a sample from the muscle layer.^[8] Complete removal of all visible tumor during the initial surgery is essential for good outcomes.^[3]

Intravesical therapy: Because stage I bladder cancer often comes back after surgery, most people receive additional treatment given directly into the bladder. This is called intravesical therapy. The treatment is placed into the bladder through a catheter.^[8]

Two main types of intravesical therapy are used:

• Intravesical chemotherapy: Drugs such as mitomycin or gemcitabine are placed directly into the bladder, often at the time of the first surgery^[8]
• Intravesical BCG: BCG is a type of immunotherapy that helps your immune system fight cancer cells. It is commonly used for higher-risk stage I cancers^[8]

Maintenance therapy: To help lower the risk of the cancer coming back, your doctor may recommend continuing intravesical BCG for up to one to three years, depending on how aggressive the cancer is. This ongoing treatment is called maintenance therapy.^[8]

The specific treatment plan depends on several factors, including how deeply the cancer has grown into the lamina propria and the grade of the cancer cells. High-grade cancers and those that invade more deeply into the connective tissue are more likely to progress and may require more intensive treatment.^[3]

Outlook and follow-up care

Stage I bladder transitional cell carcinoma has a high rate of recurrence and progression. This means the cancer often comes back and may advance to a more serious stage. Studies show that this stage of bladder cancer is associated with significant implications for survival and quality of life.^[3]

Because of the high risk of recurrence, regular follow-up care is extremely important. Your doctor will need to monitor you closely using regular cystoscopies, where they inspect the inside of your bladder with a camera. You may also need additional imaging tests to watch for signs that the cancer has returned or progressed.^[8]

Important factors that affect outlook include the grade of the cancer and how deeply it has invaded the lamina propria. High-grade cancers and those that invade more deeply carry a higher risk of progression.^[3]

When caught early and treated properly, stage I bladder cancer is treatable. However, because these cancers often come back, ongoing surveillance and prompt treatment of any recurrence are essential.^[1]