Bladder Cancer Stages and Prognosis

While bladder cancer is relatively common, the average five-year survival rate is quite high at 76.9%. This rate has improved over the past several years, and a person's chance of survival is influenced by many factors. These factors include the type, stage, and grade of the cancer.

Survival rates are also classified by the stage: localized, regional, and distant. If the cancer is found earlier, the chance of survival is higher.

Survival Rates

Relative survival is an estimate of the percentage of people who would be expected to survive the effects of their cancer. The five-year relative survival rate measures how many people will survive five years or more after being diagnosed. It is estimated based on epidemiological data collected by the National Cancer Institute’s SEER program.

These rates are classified by stage: localized, regional, and distant. Cancer is considered localized when it is only found in the part of the body where it started. Regional means the cancer has spread to nearby lymph nodes or organs and tissues, while distant refers to cancer that has metastasized to distant organs or lymph nodes.

The earlier the cancer is found, the higher the chances of survival. For bladder cancer, the five-year relative survival rate when the cancer is at the localized stage is 69.2%.

Factors That Influence Survival

Prognosis describes how severe a person's cancer is and their chances of survival. It is influenced by factors that are not reflected in the SEER survival statistics. Chief among them are the type, stage, and grade of bladder cancer. Other factors also contribute.

Cancer Type

The two most common types of cancer affecting the bladder are:

• Transitional cell carcinoma (TCC): Transitional cell carcinoma of the bladder starts in the bladder. In a study of 33,761 patients in Norway, transitional cell carcinoma accounted for 95% of bladder cancer cases.
• Non-transitional cell carcinoma: This is a rarer form of bladder cancer, and it includes adenocarcinoma, squamous cell carcinoma, sarcoma, and small cell carcinoma. In a study examining 125 patients with non-transitional cell bladder cancer, those who were treated with a radical cystectomy and adjuvant treatment had a significantly improved prognosis, which was true for all histological types.

Papillary TCC (papillary carcinoma) and non-papillary TCC (flat carcinoma) are different in that the former tends to be slow-growing and non-invasive while the latter is more invasive and likely to recur.

Cancer Spread

Bladder cancer can also be categorized by how far it has spread:

• Muscle-invasive bladder cancer: This type of bladder cancer has spread to the detrusor muscle in the bladder wall and is also more likely to spread to other parts of the body. Approximately 20% of newly diagnosed bladder cancer cases are muscle-invasive.
• Non-muscle-invasive bladder cancer: The cancer in this case is confined to the inner surface of the bladder and does not involve the bladder muscle. Some cases may progress to muscle-invasive bladder cancer.

This critical distinction between these two types of bladder cancer has a significant impact on surgical treatment, whether chemotherapy is recommended, chance of recurrence after treatment, and overall prognosis.

Cancer Staging

TNM staging is another system used to classify cancer stages. It takes into account tumor size, spread to nearby lymph nodes, and distant metastasis. Its purpose is to measure and communicate the extent of tumor growth. There are five TNM stages, from 0 to 4. The lower the stage number, the smaller the spread of cancer.

The SEER stages are frequently used by tumor registries but not always understood by physicians. Physicians use the TNM system to categorize cancer stages instead.

Tumor Grading

Tumor grade is the description of a tumor based on how abnormal the tumor cells and the tumor tissue look under a microscope. It is an indicator of how quickly a tumor is likely to grow and spread. When the cells of the tumor and the organization of the tumor’s tissue are close to those of normal cells and tissue, the tumor is considered well-differentiated. These tumors tend to grow and spread at a slower rate than tumors that are undifferentiated or poorly differentiated, which have abnormal-looking cells and may lack normal tissue structures.

Based on these and other differences in microscopic appearance, doctors assign a numerical grade to most cancers, including bladder cancer. The factors used to determine tumor grade and the grading system can vary between different types of cancer. Tumor grading for bladder cancer classifies tumors as high-grade and low-grade. A high-grade tumor grows and spreads more quickly than a low-grade tumor.

Other Factors

Bladder cancer prognosis can also be affected by modifiable and non-modifiable factors. Modifiable factors such as lifestyle factors can be changed, whereas non-modifiable factors like age and sex cannot.

The factors influencing survival include:

• Age: Increasing age has been linked to a lower survival rate in people with bladder cancer.
• Sex: A literature review of 27 studies and 23,754 patients found that women had a greater risk for disease recurrence following localized treatment of non-muscle-invasive bladder cancer.
• Smoking: Smoking increases the risk of recurrence and mortality in people with bladder cancer.
• Recurrence: Recurrence of bladder cancer forebodes a poor prognosis, with a median survival of six months after recurrence. Although people with local recurrence have a slightly better prognosis, those with disease recurrence at local and distant sites perform very poorly.

Cancer Remission 

Remission means that the signs and symptoms of cancer are reduced. There is complete remission or response (CR) and partial remission or response (PR). Complete remission means all signs of cancer have disappeared, while partial remission refers to a decrease in the size of a tumor, or the extent of cancer in the body, in response to treatment.

Most bladder cancers are highly treatable. Many cases of bladder cancer are also caught early, which increases a person's chances of survival. Even so, some early-stage bladder cancers can recur, and ongoing monitoring is required even if complete remission is achieved. Most recommend follow-up visits every three to six months. If several years have gone by with no cancer recurrence, once-yearly visits may be all that is needed.