Bladder cancer originates when cells in the lining of the bladder begin to grow abnormally and uncontrollably. This organ, located in the lower abdomen, functions as a reservoir for urine. The way these abnormal cells appear under a microscope, known as their “grade,” is an important factor in determining the cancer’s behavior and guiding treatment decisions.
Defining Low-Grade Bladder Cancer
Low-grade bladder cancer is characterized by cancer cells that closely resemble normal, healthy bladder cells when viewed under a microscope. Pathologists describe these cells as “well-differentiated,” meaning they maintain a more organized structure and appearance similar to typical tissue. This type of cancer tends to grow slowly and is less likely to invade the deeper muscular wall of the bladder or spread to other parts of the body.
Non-invasive papillary urothelial carcinoma (Ta) is a common presentation of low-grade disease. Here, the tumor grows in finger-like projections from the bladder’s inner lining but has not invaded into the underlying connective tissue or muscle. While low-grade tumors can recur, only a small percentage, approximately 10%, may become invasive.
Identifying Low-Grade Bladder Cancer
The most common initial symptom of bladder cancer is hematuria, or blood in the urine, which can appear as pink, red, or cola-colored. Other symptoms include frequent or painful urination, or a sudden urge to urinate.
Cystoscopy is a primary diagnostic tool, involving the insertion of a thin, flexible tube with a camera into the urethra to visually inspect the inside of the bladder. A urine cytology test may also be performed, where urine is examined under a microscope for the presence of cancer cells.
A definitive diagnosis and grading are made through a biopsy, which involves taking a tissue sample from any suspicious areas during cystoscopy. This tissue sample is then sent to a pathologist, who meticulously examines the cells under a microscope to determine the type and grade of the cancer. Imaging tests like a CT urogram can also be used to visualize the urinary tract and check for any spread, though less critical for the initial diagnosis of low-grade, non-invasive bladder cancer.
Managing Low-Grade Bladder Cancer
The main treatment for low-grade bladder cancer is a procedure called Transurethral Resection of Bladder Tumor (TURBT). This minimally invasive surgical procedure involves inserting a specialized instrument through the urethra into the bladder to remove the tumor. The goal of TURBT is to completely remove the visible tumor.
Following TURBT, some patients may receive intravesical therapy, which involves delivering medications directly into the bladder. This is often done to reduce the risk of the cancer returning. A common agent used for immediate post-operative instillation is chemotherapy, such as Mitomycin C, which helps to destroy any remaining cancer cells.
While Bacillus Calmette-Guérin (BCG) is another form of intravesical therapy, it is reserved for higher-risk non-muscle-invasive bladder cancer due to its potent immune-stimulating effects. For low-grade bladder cancer, extensive surgery, such as removing the entire bladder (cystectomy), is rarely necessary because the cancer does not typically invade deeply into the bladder wall.
Life After Low-Grade Bladder Cancer
Individuals diagnosed with low-grade bladder cancer have a favorable long-term outlook. However, a notable characteristic of this cancer is its high rate of recurrence within the bladder itself. Studies indicate that recurrence can occur in 40% to 80% of patients within a few years of initial treatment.
Due to this high recurrence rate, regular follow-up cystoscopies are important for early detection of any new tumors. Surveillance often begins with cystoscopies every three to six months for the first few years, with less frequent checks if the bladder remains clear. While recurrences are usually low-grade, there is a small possibility that the cancer could progress to a more aggressive, high-grade form over time.
Adhering to surveillance appointments is important for timely intervention. Lifestyle changes can also reduce the risk of recurrence, including:
- Quitting smoking
- Maintaining a healthy diet rich in fruits and vegetables
- Staying well-hydrated
- Engaging in regular physical activity