STAGES OF BLADDER CANCER

Stages

The American Cancer Society estimates that 70,980 new cases of bladder cancer will be diagnosed in 2009. Approximately 14,330 people will die from the disease. Once bladder cancer has been diagnosed, more testing will be done to see how far the cancer has spread-a process called staging. Your treatment options will vary depending on the stage of your disease.
The following stages are used for bladder cancer:

• Stage 0 or Carcinoma in Situ: At this stage the cancer is found only on the inner lining of the bladder. After the cancer is taken out, no swelling or lumps are felt during an internal examination. During this stage, treatment may be one of the following:
  
  
  • Removal of the cancer using a cystoscope inserted through the urethra to cut out the tumor and burn away any remaining cancer cells (transurethral resection with fulguration).
  • Transurethral resection with fulguration followed by an injection of BCG (bacillus Calmette-Guerin) into the bladder through a tube inserted into the urethra (intravesical).
  • Transurethral resection with fulguration followed by intravesical chemotherapy.
  • Surgery to remove part of the bladder (segmental cystectomy).
  • Surgery to remove the whole bladder and organs around it (radical cystectomy).
  • A clinical trial of photodynamic therapy.
  • A clinical trial of intravesical biological therapy.
  • After treatment for the cancer, a patient may be given chemotherapy to prevent the cancer from coming back.
    
    

• Stage I: At this stage the cancer has spread a little deeper into the inner lining of the bladder but has not spread to the muscular wall of the bladder. During this stage, treatment may be one of the following:
  
  
  • Removal of the cancer using a cystoscope inserted through the urethra to cut out the tumor and burn away any remaining cancer cells (transurethral resection with fulguration).
  • Transurethral resection with fulguration followed by an injection of BCG (bacillus Calmette-Guerin) into the bladder through a tube inserted into the urethra (intravesical).
  • Transurethral resection with fulguration followed by intravesical chemotherapy.
  • Surgery to remove part of the bladder (segmental cystectomy).
  • Surgery to remove the whole bladder and organs around it (radical cystectomy).
  • Placing radioactive substances within or around the tumor, possibly followed by radiation therapy.
  • A clinical trial of chemotherapy to prevent the cancer from coming back after a patient has been treated for cancer.
  • A clinical trial of intravesical therapy.
    
    
• Stage II: At this stage, the cancer has spread to the inside lining of the muscles lining the bladder. Treatment may be one of the following:
  
  
  • Surgery to remove the whole bladder and the organs around it (radical cystectomy). The lymph nodes in the pelvis may also be removed (lymph node dissection).
  • Radiation therapy.
  • Placing radioactive substances within or around the tumor before or after radiation therapy.
  • Removal of the cancer using a cystoscope inserted through the urethra to cut out the tumor and burn away any remaining cancer cells (transurethral resection with fulguration).
  • Surgery to remove part of the bladder (segmental cystectomy).
  • A clinical trial of chemotherapy before cystectomy (neoadjuvant chemotherapy) or after cystectomy (adjuvant chemotherapy), or chemotherapy plus radiation therapy.
    
    
• Stage III: At this stage, the cancer has spread throughout the muscular wall of the bladder to the layer of tissue surrounding the bladder and/or to the nearby reproductive organs. A doctor may feel for swelling or lumps after a patient has had an operation to take out the cancer. Treatment may be one of the following:
  
  
  • Surgery to remove the whole bladder and the organs around it (radical cystectomy).
  • Radiation therapy.
  • Placing radioactive substances within or around the tumor followed by radiation therapy.
  • Surgery to remove part of the bladder (segmental cystectomy). · Radiation therapy plus chemotherapy.
  • A clinical trial of systemic chemotherapy before cystectomy (neoadjuvant chemotherapy), or after cystectomy (adjuvant chemotherapy), or chemotherapy plus radiation therapy.


• Stage IV: At this stage, the cancer has spread to the wall of the abdomen or pelvis or to the lymph nodes in the area. The cancer may have also spread to other parts of the body far away from the bladder.
  
  If a patient has Stage IV bladder cancer that has spread to nearby tissue or lymph nodes but not to other parts of the body, treatment may be one of the following:
  
  
• Surgery to remove the whole bladder and the organs around it (radical cystectomy).
• Radiation therapy.
• Surgery to make a way for urine to pass out of the body without going through the bladder (urinary diversion) or surgery to remove the bladder (cystectomy) to relieve symptoms caused by the cancer.
• Chemotherapy following one of the previous treatments.
• A clinical trial of systemic chemotherapy before cystectomy (neoadjuvant chemotherapy), or after cystectomy (adjuvant chemotherapy), or chemotherapy plus radiation therapy.
  If the cancer is found in lymph nodes or other places far away from the bladder, treatment may be one of the following:
  
  
• Chemotherapy alone or in addition to surgery.
• Radiation therapy to relieve symptoms caused by the cancer.
• Urinary diversion or cystectomy to reduce symptoms caused by the cancer.
• A clinical trial of chemotherapy.
  
  
• Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may recur in the bladder or in another part of the body. If cancer comes back only in the bladder, treatment may be surgery, chemotherapy, or radiation therapy, depending on what treatment the patient received when cancer first appeared. If the cancer comes back following surgery to remove all of the bladder, a patient may receive chemotherapy. A patient may also choose to participate in a clinical trial.