The gold standard for diagnosing bladder cancer is biopsy obtained during cystoscopy. Sometimes it is an incidental finding during cystoscopy. Urine cytology can be obtained in voided urine or at the time of the cystoscopy ("bladder washing"). Cytology is very specific (a positive result is highly indicative of bladder cancer) but suffers from low sensitivity (a negative result does not exclude the diagnosis of cancer). There are newer urine bound markers for the diagnosis of bladder cancer. These markers are more sensitive but not as specific as urine cytology. They are much more expensive as well.
Many patients with a history, signs, and symptoms suspicious for bladder cancer are referred to a urologist or other physician trained in cystoscopy, a procedure in which a flexible tube bearing a camera and various instruments is introduced into the bladder through the urethra. Suspicious lesions may be biopsied and sent for pathologic analysis.
Pathological classification
90% of bladder cancers are Transitional cell carcinoma. The other 10% are squamous cell carcinoma, adenocarcinoma, sarcoma, small cell carcinoma and secondary deposits from cancers elsewhere in the body.
CIS invariably consists of cytologically high grade tumour cells.
Staging
The following stages are used to classify the location, size, and spread of the cancer, according to the TNM (tumor, lymph node, and metastasis) staging system:
- Stage 0: Cancer cells are found only on the inner lining of the bladder.
- Stage I: Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.
- Stage II: Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.
- Stage III: Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.
- Stage IV: Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.
- Recurrent: Cancer has recurred in the urinary bladder or in another nearby organ after having been treated.
Bladder TCC is staged according to the 1997 TNM system:
- Ta Non-invasive papillary tumour
- T1 Invasive but not as far as the muscular bladder layer
- T2 Invasive into the muscular layer
- T3 Invasive beyond the muscle into the fat outside the bladder
- T4 Invasive into surrounding structures like the prostate, uterus or pelvic wall
The nomenclature "G1", "G2" and "G3" refers to the degree of differentiation, or histopathological grade. "G1" superficial tumour is well differentiated, while a "G3" tumour is poorly differentiated.
Further Reading
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