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Bladder cancer diagnosis involves looking at the bladder through a scope (cystoscopy), testing the urine for abnormal cells under the microscope (cytology), and sometime involves taking a tissue sample from the bladder to check for cancer under a microscope (biopsy). Once the diagnosis of bladder cancer is established, it is important to stage the cancer to begin the appropriate treatment.
Staging and treatment relies heavily on tissue obtained at the time of transurethral resection of the bladder tumor (TURBT) where the tumor is excised endoscopically through a cystoscope. Treatment decisions are heavily based on the aggressiveness of the tumor (pathologic grade) and the layer of the bladder that is involved with the tumor (pathologic stage). It is imperative to obtain a sample of the muscle of the bladder at the base of the tumor in order to ascertain whether the tumor has invaded the muscular layer. The so-called ‘superficial’ or non-invasive bladder tumors arise from the mucosal (or the innermost) layer of the bladder wall and are usually completely resected during a TURBT. Tumors that have invaded the thin layer of connective tissue just deep to the mucosal layer called the lamina propria (stage T1), require special attention, since up to 30% may have evidence of muscle invasion on re-resection or repeat TURBT. If there is adequate muscle present in the pathology specimen to ascertain the absence of muscle invasion, these tumors can be treated with intravesical chemotherapy or immunotherapy (solutions placed inside the bladder through a catheter). BCG (the tuberculin vaccine) is often used for intravesical therapy and can be very effective in reducing recurrence rates. Treatment options for muscle-invasive bladder cancer differ significantly than their non-invasive counterparts.
