If your doctor suspects or observes signs of recurrent bladder cancer, the next step will typically be to have the suspicious areas or tumors removed from your bladder in a procedure called transurethral resection of bladder tumor, often abbreviated as TURBT (or TUR or TURB) or simply called resection.

If you have been diagnosed with recurrent bladder cancer, you most likely have already experienced a TURBT procedure, where your doctor removed your tumor(s) under anesthesia.  This is done by inserting a small wire loop through your urethra into your bladder.  The loop cuts or burns away the cancerous cells with an electric current (fulguration).

A pathologist, a doctor who identifies diseases by studying cells and tissues under a microscope, will examine any tumors or suspicious areas removed during your TURBT procedure to determine its stage and grade. The result of this procedure gives your urologist, who specializes in diseases of the urinary organs, essential information to take into account when making decisions about your next treatment steps. Your individual treatment plan will depend upon many factors, including the type and clinical stage of the cancer, the tumor’s grade, previous treatments used, the amount of time passed since the last course of treatment and your age and underlying medical conditions.

The two most important factors in evaluating bladder cancer tumors are:

• Grade (the higher the grade the more aggressive the tumor cells)

You may hear doctors talk about the grade of your cancer. This means how well developed the cells look under a microscope. With low grade cancers (G1), the cells look very similar to normal cells and tend to grow slowly. High grade cancers (G3) tend to grow more quickly and are more likely to spread.

• Stage (how deeply the cancer has penetrated the bladder wall)

Cancers are divided into stages, depending on how deeply they have grown. Cancer that is only in the innermost lining of the bladder is classified as either carcinoma in situ (CIS or Tis), in situ meaning ‘in-place’ or in one spot, or Ta. In stage 1 or T1, the cancer has started to grow into (or invade) the connective tissue just under the bladder lining but has not progressed to the next layer called the muscle layer. Ta, T1 and CIS tumors are classified as non-muscle invasive bladder cancer. Treatment of non-muscle invasive bladder cancer is discussed in this website.

Cancer that has spread at least as far as the bladder muscle has a T number from 2 to 4. Bladder cancer that is stage T2 or higher is called muscle-invasive bladder cancer, which means the cancer has progressed through the superficial layers of the bladder and into the muscle. This is generally considered a serious sign and usually requires a different treatment approach compared to non-muscle invasive bladder cancer. Treatment of muscle-invasive bladder cancer (stages T2-T4) is different from non-muscle invasive bladder cancer and is not covered here.  For more information on muscle-invasive bladder cancer and its treatment, visit the section on Frequently Asked Questions on BCAN’s main website.

Ta papillary tumors are shaped like a cauliflower, with a “stalk” attached to the inner lining of the bladder and a “flower” that grows towards the hollow center of the bladder. Papillary bladder tumors are usually low grade (most closely resembling normal cells) and, even though a large majority will recur multiple times after the initial diagnosis and removal, there is a minimal probability of progression to muscle invasion. Ta tumors progress in grade in up to 15% of patients. Thankfully, these tumors become invasive less than 5% of the time, and are rarely life-threatening.

T1 tumors have grown into the lamina propria, the connective tissue just below the bladder lining (urothelium) but have not yet invaded the bladder muscle. T1 tumors are most often high grade and have a 30 to 50% chance of progression to muscle-invasive bladder cancer.

Carcinoma in situ (CIS) look like flat red patches on the surface of the bladder.  CIS is more aggressive than Ta tumors and is usually treated with more aggressive treatment because the statistics suggest that these tumors may be more likely to recur.

Although these tumors are all non-muscle invasive, their outcomes can be quite different. Ask your doctor about your grade and stage and how it might affect the probability of recovery or recurrence for you.