Muscle invasive bladder cancer
The consultant looking after you will have told you that you have ‘muscle invasive bladder cancer’. This is likely to be based upon the microscopic examination of the bladder wall specimens that have been resected from your bladder (the histology) at the time of your TURBT (see section on TURBT )
This diagnosis is an important step towards appropriate management of your cancer and involves accurate cancer staging.
Staging of your bladder cancer is a crucial part of cancer management. It helps the clinician to decide the best treatment for you and allows him to give you some idea of how the cancer will behave over subsequent years (i.e. the prognosis).
Bladder cancer staging, like for other cancers, depends upon assessment of the depth of invasive of the cancer (T stage) whether the cancer has effected draining lymph nodes (N stage) and whether it has spread elsewhere in the body (ie metastasised M stage). This is known as the TNM staging classification of the cancer.
The T stage of bladder cancer can be subdivided according to how deeply it has invaded into and through the bladder wall.
| Stage | Ta: the cancer is limited to the lining cells of the bladder |
| T1: the cancer has invaded into the first layer (the lamina propria) of the bladder | |
| T2: the cancer has invaded into the muscle layer (aka detrusor muscle or muscularis propria) of the bladder |
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| T3: the cancer has invaded through the muscle layer of the bladder and into fat surrounding the bladder |
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| T4: the cancer has invaded outside of the bladder and has involved other organs close to the bladder (eg colon, uterus, vagina, prostate) |
Bladder cancers of T stage Ta or T1 are known as non-muscle invasive bladder cancers and in many cases can be managed conservatively (see non-muscle invasive bladder cancer).
If you have been diagnosed with a muscle-invasive bladder cancer then you will have a T stage T2-T4 cancer. You may have been diagnosed with this cancer following your first bladder cancer endoscopic resection or this may have been diagnosed after a period of surveillance of a non-muscle invasive cancer. In either scenario it is likely that your clinician will suggest that you need further cancer staging and additional treatment. In the vast majority of cases it cannot be assumed that transurethral resection (TURBT) alone is adequate management for muscle invasive bladder cancer.
The first step in your management will be to accurately stage the cancer to assess:
- how far the cancer has invaded through the bladder wall (ie T stage)
- if any lymph nodes within the abdomen or chest are enlarged (ie N stage)
- N0 – no cancer in any lymph nodes
- N1 – one affected lymph node in the pelvis (the lower part of your tummy)
- N2 – more than one lymph node in the pelvis is affected
- N3 – one or more affected lymph nodes in the groin
- the distance that the cancer has spread (ie metastasis M stage)
- M0 – no metastasis
- M1 – metastasis
Accurate staging is likely to require CT or MRI scans of the chest abdomen and pelvis.
Once accurate staging is available your clinician will be able to give you an indication of your likely stage (eg T2N0M0) and how the cancer is likely to behave. This will lead to a discussion about possible treatment options. These treatment options will usually involve a primary definitive treatment which will be either
- Surgery to remove the bladder and draining lymph nodes (radical cystectomy and lymphadenectomy)
OR - Radical Radiotherapy to the bladder
In addition to these primary treatments your clinician may suggest that you consider receiving a course of chemotherapy. This can be administered either before the definitive treatment (neoadjuvant chemotherapy) or after this treatment (adjuvant chemotherapy).
