Bladder Cancer (cont.)

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What is bladder cancer grading?

Grading of bladder cancer is done by the pathologist by examination of the tumor specimen under a microscope. It is a measure of the extent by which the tumor cells differ in their appearance from normal bladder cells. The greater the distortion of appearance, the higher the grade assigned. High-grade cancers are more aggressive than low-grade ones and have a greater propensity to invade into the bladder wall and spread to other parts of the body. An example of grading is listed as follows:

  • Grade 1 cancers have cells that look very much like normal cells. They are called low grade or well differentiated and tend to grow slowly and are not likely to spread.
  • Grade 2 cancers have cells that look more abnormal. They are called medium grade or moderately differentiated and may grow or spread more quickly than low grade.
  • Grade 3 cancers have cells that look very abnormal. They are called high grade or poorly differentiated and are more quickly growing and more likely to spread.

Depending upon which cancer organization your clinician follows, the grades above may differ slightly. In general, they all follow the same pattern. Bladder cancers with a higher number (zero through four) are considered more aggressive and more difficult to treat.

In 2004, the World Health Organization developed a new grading system for bladder cancer. This system divides bladder cancers into the following groups.

  • Urothelial papilloma - Noncancerous (benign) tumor
  • Papillary urothelial neoplasm of low malignant potential (PUNLMP) - Slow growing and unlikely to spread (some clinicians lump urothelial papillomas and PUNLMP neoplasms together)
  • Low-grade papillary urothelial carcinoma - Slow growing and unlikely to spread
  • High-grade papillary urothelial carcinoma - More quickly growing and more likely to spread

However, the World Health Organization (WHO) has recommended changing bladder grading to only two categories; the first category being well differentiated or low grade and the second category being poorly differentiated or high grade. These categories are being adopted by the American Joint Committee on Cancer (AJCC). The older categories listed above may still be used by some clinicians and may be listed in individual patient's medical records, so they were included here.

Stage and grade of bladder cancer play a very important role not just in deciding the treatment that an individual patient should receive but also in quantifying the chances of success with that treatment. Of note, carcinoma in situ (CIS or Tis, as mentioned in the section on staging) is always high grade.

What is transurethral surgery (TURBT) for bladder cancer?

The initial surgical procedure that a patient undergoes after the diagnosis of bladder cancer is established is usually a transurethral resection of bladder tumor or "TURBT." It is done with the help of special instruments attached to a cystoscope (mentioned earlier in the section on investigations) and involves cutting out the tumor and removing it from the bladder with the help of an electrical cautery device. This surgery is done through the normal urinary passage and does not involve an external cut on the body. It is the initial treatment of bladder cancer as well as a staging procedure since the specimen retrieved from the surgery is sent to a pathologist who gives his/her inference on the depth of invasion of the tumor in the bladder wall (T stage) as well as the grade (high/low). Further treatment depends to a large extent on the findings of this initial surgery as well as the other staging investigations and is covered in the sections to follow. TURBT is the most common treatment for bladder cancer.

Medically Reviewed by a Doctor on 1/8/2015

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