Bladder Cancer Stage II

Stage 2 bladder cancer is a form of muscle-invasive bladder cancer where cancer cells have grown through the connective tissue layer into the muscle wall of the bladder, but have not spread to lymph nodes or other parts of the body.

Table of contents

• What is stage 2 bladder cancer?
• Symptoms
• Causes and risk factors
• How doctors diagnose stage 2 bladder cancer
• Treatment options
• Potential complications
• Outlook and recovery

What is stage 2 bladder cancer?

Stage 2 bladder cancer is often described as muscle-invasive bladder cancer^[1]. At this stage, cancer cells have spread beyond the original tumor site but remain within the bladder area. The tumor has grown through the connective tissues lining the bladder and invaded the inner layer of the bladder muscle^[1].

The cancer has not affected surrounding lymph nodes or distant sites in the body^[1]. Stage 2 may be further divided into substages. In stage 2a, the cancer has grown into the superficial muscle, while in stage 2b, it has grown into the deeper muscle layers^[3].

Stage 2 bladder cancer is treatable and often curable^[4]. This stage represents an important point in treatment decisions, as it typically requires more aggressive approaches than earlier stages.

Symptoms

Blood in urine, also called hematuria, is the most common symptom of bladder cancer^[1]. It may appear as streaks of blood in the urine or the urine may appear brown. Blood in the urine is often one of the first signs that prompts people to see a doctor^[4].

A person with stage 2 bladder cancer may experience other symptoms, ranging from mild to severe. Additional symptoms can include^[1]:

• Inability to urinate
• Pelvic pain
• Unexplained weight loss
• Loss of appetite
• Back pain

Some less common symptoms of bladder cancer include^[1]:

• Sudden urge to urinate
• Frequent urination
• Painful sensation while passing urine
• Feeling like you have to urinate even when you don’t

Causes and risk factors

Medical experts do not know exactly what causes bladder cancer. However, they have identified several factors that can increase a person’s risk of the condition^[1].

Possible risk factors for bladder cancer include^[1]:

• Smoking cigarettes, which causes about half of all bladder cancers
• Workplace exposure to certain chemicals, such as aromatic amines
• Exposure to arsenic in drinking water
• Not drinking enough fluids
• Taking certain medications or supplements, such as pioglitazone and products containing aristolochic acid
• Having chronic bladder conditions, such as urinary infections, kidney stones, and bladder stones
• Personal or family history of bladder cancer
• Age, as bladder cancer is more common in people over age 55 years

It is best for a person to contact their doctor if they have concerns about the risk factors of bladder cancer^[1].

How doctors diagnose stage 2 bladder cancer

If a doctor suspects bladder cancer, they may start by performing a physical examination, taking a medical history, and ordering various tests^[1]. Testing will likely include urinalysis, or a urine test, to check for blood, infection, and abnormal cells.

Other tests can help a doctor confirm the diagnosis and determine the stage of the cancer.

Cystoscopy

This procedure helps a doctor view the inside of the urethra (the tube that carries urine out of the body) and bladder^[1]. A cystoscope is a thin tube with a lens and lighting system that provides a complete view of the bladder. The doctor may administer anesthesia to make the procedure painless before inserting the cystoscope into the urethra.

Tissue biopsy

A tissue biopsy involves a healthcare professional removing a small sample of tissue for examination under a microscope^[1]. This helps confirm whether cancer is present and determine its characteristics.

Treatment options

Treatment for stage 2 bladder cancer typically involves a combination of approaches^[4]. Your treatment options will depend on a number of factors, such as your age and general health. Your doctor will monitor your progress and adjust therapy as needed.

Chemotherapy

Chemotherapy is almost always offered for stage 2 bladder cancer^[5]. It is often given before radical cystectomy surgery, but it can be given after surgery if it wasn’t already used. Chemotherapy may also be used alone if surgery can’t be done.

Chemotherapy is given as a systemic therapy through a needle into a vein. A combination of chemotherapy drugs that includes cisplatin is standard treatment for stage 2 bladder cancer^[5].

If you are being treated with a bladder-preserving approach, chemotherapy is most often used as a part of chemoradiation. It may include cisplatin or 5-fluorouracil with mitomycin. Chemoradiation is given after a transurethral resection of bladder tumor (TURBT) so the bladder doesn’t have to be removed^[5].

Surgery

Surgery is a main treatment for stage 2 bladder cancer^[5]. In most cases, at least one of the following surgeries is done.

A cystectomy removes all or part of the bladder. A radical cystectomy to remove the whole bladder is most commonly done^[5]. A radical cystectomy involves removal of the bladder, tissue around the bladder, the prostate and seminal vesicles in men, and the uterus, fallopian tubes, ovaries, anterior vaginal wall, and urethra in women^[9].

Once the bladder is removed, urinary diversion surgery is needed to make a new way to hold urine and pass it out of the body^[5]. With the creation of artificial bladders, referred to as continent reservoirs or “neobladders,” that preserve voiding function, a radical cystectomy is now a far more acceptable procedure^[9].

A pelvic lymph node dissection (PLND) removes lymph nodes from the pelvis. It is done following a radical cystectomy, usually during the same surgery^[5].

A transurethral resection of bladder tumor (TURBT) removes tumors from the bladder through the urethra. It may be done if you are being treated with a bladder-preserving approach^[5].

Radiation therapy

You may be offered external radiation therapy for stage 2 bladder cancer^[5]. It may be given as a part of chemoradiation after a TURBT. External radiation therapy may also be used alone if surgery can’t be done.

Targeted therapy

Targeted therapy is sometimes used to treat locally advanced bladder cancer^[5]. Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer and limit harm to normal cells. Erdafitinib can be used to treat locally advanced bladder cancer that has mutations in the FGFR2 or FGFR3 gene and doesn’t respond to chemotherapy.

Immunotherapy

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer^[5]. You may be offered an immune checkpoint inhibitor for stage 2 bladder cancer that is still growing during or after chemotherapy, comes back within 12 months of finishing chemotherapy, can’t be treated with surgery or chemotherapy, or has a high risk of coming back after surgery.

Bladder-preserving approach

Most often the whole bladder needs to be removed. But sometimes it may be possible to keep the bladder, which is called a bladder-preserving approach^[5]. The order you receive treatments depends on if you are offered a bladder-preserving approach or not.

Clinical studies increasingly suggest that bladder removal may be avoided in a majority of patients using a combined approach consisting of chemotherapy, followed by limited surgery, immunotherapy and close surveillance^[9].

Potential complications

Stage 2 bladder cancer treatment can cause changes to your body that may affect how you feel about yourself^[4]. The physical changes you have depend on what treatment you receive.

Surgery to remove the bladder will require creation of a new way to hold and pass urine^[5]. This represents a significant adjustment that requires adaptation and learning new self-care techniques.

Treatment with radiation therapy or chemotherapy may cause side effects that can affect your daily life. Your healthcare team will work with you to manage these effects and provide support throughout your treatment.

Outlook and recovery

Stage 2 bladder cancer is treatable and often curable^[4]. Recovery and survival rates are higher for patients who are treated at a comprehensive medical center with a multidisciplinary team of experts^[17].

After completing treatment, regular follow-up care is essential. Bladder cancer may come back after treatment, so people with the disease should be vigilant about following up with their healthcare providers^[8].

To help reduce the risk of recurrence, you can take several steps^[18]:

• Quit smoking, as smoking is thought to be the cause of about half of all bladder cancers
• Stay hydrated by drinking six to eight glasses of water a day
• Eat a diet high in fruits and vegetables, aiming for at least five servings every day
• Exercise regularly, as only 30 minutes a day of moderate exercise can reduce anxiety and symptoms

It’s normal to have concerns and fears about cancer returning. Acknowledging your fears, learning about the disease, expressing yourself to others, and finding ways to relax can help you manage anxiety^[18].

Your clinical and support teams are not just here to manage your cancer; they are here to care for you^[17]. A multidisciplinary team including experienced specialists, nurses, and social workers will work together to provide comprehensive care tailored to your needs.