by Non-muscle invasive bladder cancer (NMIBC) starts in the cells lining the bladder but has not yet spread into the muscular wall of the bladder. It is also known as shallow or superficial bladder cancer. The two main types of NMIBC are:
– Papillary urothelial carcinoma: This starts in the layer of cells lining the inside surface of the bladder. It often appears as a small growth or cluster of cells that usually stay confined to the lining of the bladder.
– Flat urothelial carcinoma in situ (CIS): This starts in the layer of cells lining the inside surface of the bladder but may look flat rather than growing as a growth. CIS is more likely to recur or progress to a more advanced stage bladder cancer than papillary urothelial carcinoma.
Symptoms Of Non-Muscle Invasive Bladder Cancer
The most common symptoms of NMIBC are:
– Blood or blood clots in the urine (hematuria): This occurs in about 85-90% of cases and can be intermittent or persistent. The urine may appear red, pink, or cola-colored.
– Urgency to urinate: A sudden urge or need to urinate often and immediately. This symptom occurs in 50-70% of cases.
– Pain or burning sensation during urination: This occurs in 30-40% of cases. The sensation may feel similar to a urinary tract infection but without other symptoms like fever.
– Pelvic pain: Dull or aching pain in the lower abdomen, pelvis, or back that may happen sometimes with or without urination.
Diagnosis Of NMIBC
The diagnostic tests for NMIBC include:
– Urine cytology: Examining urine cells under a microscope to check for signs of cancer cells. It has limited accuracy for low-grade Non-Muscle Invasive Bladder Cancer.
– Cystoscopy: Direct visual examination of the inside of the bladder using a thin tube with a camera (cystoscope) inserted through the urethra. The doctor can see and remove any visible tumors for biopsy.
– Biopsy: Removal of small tissue samples during cystoscopy to examine tumor cells under the microscope to determine the type and grade of bladder cancer.
– CT urography: X-ray imaging test combining a CT scan with contrast material injected into a vein to outline the urinary tract including the kidneys, ureters, and bladder. It can detect spread of cancer.
Staging And Grading Of Non-Muscle Invasive Bladder Cancer
Staging classifies the depth of penetration into the bladder wall, while grading refers to how abnormal the cancer cells appear under a microscope. The two systems used are:
– TNM Staging: Stages NMIBC as Ta, Tis, T1 based on depth of invasion.
– WHO/ISUP Grading: Grades NMIBC on a scale of 1-3 (low to high grade) based on cell appearance. Lower grade usually has a better prognosis.
Treatment And Management Of NMIBC
Treatment for NMIBC depends on the stage, grade, and risk of recurrence or progression. Common management options include:
– Transurethral resection of the bladder tumor (TURBT): Surgical removal of visible tumors using an instrument inserted through the urethra. It is needed for tissue diagnosis.
– Intravesical chemotherapy: Instilling anticancer drugs directly into the bladder through a catheter. Commonly used drugs include mitomycin C and Bacillus Calmette-Guérin (BCG).
– Second TURBT: If high grade is found, a second TURBT is often performed 4-6 weeks later to better stage and assess completeness of initial resection.
– Cystoscopy and urine cytology: Repeated periodically every 3-6 months for the first 2-3 years then annually to monitor for recurrence.
– Radical cystectomy (rare): Surgical removal of the entire bladder if cancer recurs frequently or progresses despite treatment. An ileal conduit or neobladder is formed for urine collection and drainage.
Prognosis And Follow Up
The prognosis for Non-Muscle Invasive Bladder Cancer is generally good if the cancer is low grade. 70-80% of cases do not progress to muscle invasion. However, up to 70% may recur within 5 years, especially higher grade tumors. Lifelong surveillance is needed even after treatment to monitor for recurrence and progression. Early detection of recurrence improves outlook. Radical cystectomy may be considered if cancer becomes resistant or spreads. With good management, the 5-year survival rate for NMIBC is around 80-90%.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
About Author - Priya Pandey
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