Bladder Transitional Cell Carcinoma Stage II

Bladder Urothelial Carcinoma Stage II, Stage II Muscle-Invasive Bladder Cancer, Stage II Transitional Cell Carcinoma of the Bladder

Stage II bladder cancer is a serious form of cancer where abnormal cells have invaded the muscle wall of the bladder. This type of cancer requires prompt treatment but can be managed effectively with surgery, chemotherapy, or a combination of approaches.

Table of contents

• What Is Bladder Transitional Cell Carcinoma Stage II
• Parts of the Body Affected
• Understanding Stage II
• Signs and Symptoms
• How Doctors Diagnose This Condition
• Treatment Options
• Outlook and Follow-Up

What Is Bladder Transitional Cell Carcinoma Stage II

Bladder transitional cell carcinoma, also called urothelial carcinoma, is cancer that starts in the special cells lining 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].

This type of cancer accounts for about 90% of all bladder cancer cases in the United States^[1]. Stage II represents a more advanced form where the cancer has grown deeper into the bladder wall compared to earlier stages.

Parts of the Body Affected

• Bladder
• Bladder muscle wall
• Connective tissue of the bladder
• Urothelium (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 to hold urine made by the kidneys and contract to push urine out of the body^[7]. The inside of the bladder is lined with urothelial cells, and beneath this lining is a layer of connective tissue, followed by layers of muscle.

Understanding Stage II

Stage II bladder cancer is also described as muscle-invasive bladder cancer. In this stage, cancer has spread through the connective tissue layer and into the muscle layers of the bladder wall^[2]. However, the cancer has not spread outside the bladder wall, to nearby lymph nodes, or to distant parts of the body^[6].

Doctors use a system called TNM staging to describe how far the cancer has spread. In Stage II, the T stage is T2, meaning the tumor has invaded the muscle. The cancer has not reached lymph nodes (N0) and has not spread to other organs (M0)^[8].

Signs and Symptoms

Symptoms may not appear right away. Blood in the urine, called hematuria, is usually the first noticeable sign^[1]. The blood may make the urine look pink, red, or brown. Sometimes the blood can only be seen under a microscope during a urine test.

Other symptoms you should contact a healthcare provider about include^[1]:

• Painful urination or a burning feeling when urinating
• Needing to urinate more often than usual
• Feeling the need to urinate urgently, even when the bladder is not full
• Fatigue or feeling very tired
• Unexplained weight loss
• Persistent low back pain

How Doctors Diagnose This Condition

Healthcare providers use several tests to diagnose bladder cancer and determine its stage^[1]:

Urine tests: Your provider will examine a urine sample to look for blood or cancer cells. This test is called a urinalysis.

Imaging tests: These create pictures of the inside of your body. You may need a CT scan (computed tomography), MRI (magnetic resonance imaging), or ultrasound to see tumors inside the bladder. An intravenous pyelogram (IVP) uses a contrast dye that makes blockages in the bladder stand out on an X-ray^[1].

Cystoscopy: This is a key test where the doctor uses a thin tube with a light and camera, called a cystoscope, to look directly inside the bladder through the urethra. During this procedure, the doctor can take tissue samples for examination under a microscope, which is called a biopsy^[1].

The biopsy helps determine the grade of the cancer (how abnormal the cells look) and the stage (how far the cancer has spread). For Stage II bladder cancer, the biopsy will show that cancer cells have invaded into the muscle layer of the bladder wall^[2].

Treatment Options

Stage II bladder cancer requires aggressive treatment because it has invaded the muscle wall. There are two main approaches to treatment^[6]:

Surgery as Primary Treatment

Radical cystectomy is the standard surgical treatment for invasive bladder cancer. This operation removes the entire bladder, the tissue around it, and nearby organs that might contain cancer cells^[6]. In men, this includes the prostate and seminal vesicles. In women, it includes the uterus, fallopian tubes, ovaries, part of the vaginal wall, and the urethra^[6].

After the bladder is removed, surgeons create a new way for the body to store and pass urine. This is called urinary diversion. Modern techniques can create artificial bladders called continent reservoirs or “neobladders” that preserve the ability to urinate in a more normal way^[6].

Doctors may also perform a pelvic lymph node dissection during the same surgery to remove and examine lymph nodes in the pelvis to check if cancer has spread^[6].

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is almost always offered for Stage II bladder cancer^[16]. Chemotherapy is often given before surgery (called neoadjuvant chemotherapy) to shrink the tumor and improve the chances of successful treatment^[16].

The standard chemotherapy for Stage II bladder cancer uses a combination of drugs that includes cisplatin^[16]. If chemotherapy was not given before surgery, it may be given after surgery to reduce the risk of cancer returning.

Bladder-Preserving Approaches

Some patients may be able to keep their bladder using a combined treatment approach. This involves chemotherapy and/or radiation therapy, sometimes along with limited surgery to remove the tumor. Patients who respond completely to this treatment are followed closely, and surgery to remove the bladder is only performed if the cancer returns^[6].

This approach may include chemoradiation, which combines chemotherapy with external radiation therapy after a procedure called transurethral resection of bladder tumor (TURBT) to remove as much of the tumor as possible^[16].

Radiation Therapy

External radiation therapy uses high-energy beams to kill cancer cells. It may be given as part of chemoradiation or alone if surgery cannot be done^[16].

Newer Treatments

Immunotherapy helps strengthen the body’s immune system to fight cancer. Immune checkpoint inhibitors may be used for Stage II bladder cancer in certain situations, such as when the cancer continues to grow during chemotherapy or comes back within 12 months of finishing chemotherapy^[16].

Targeted therapy uses drugs to target specific molecules on cancer cells. These drugs can be used to treat locally advanced bladder cancer with certain genetic characteristics^[16].

Outlook and Follow-Up

The outlook for Stage II bladder cancer depends on several factors, including the exact extent of the cancer, how abnormal the cells look under a microscope (the grade), your overall health, and how well the cancer responds to treatment^[9].

Bladder cancer, including Stage II, can come back even after successful treatment. Close follow-up care is essential^[1]. Your healthcare team will schedule regular check-ups that may include cystoscopy exams to look inside the bladder and imaging tests to check for signs of cancer returning.

You can help reduce your risk of cancer returning by making healthy lifestyle changes. If you smoke, quitting is one of the most important steps you can take, as smoking is thought to cause about half of all bladder cancers^[18]. Drinking plenty of water, eating a diet rich in fruits and vegetables, and getting regular exercise may also help protect your bladder health^[18].