Stage 2 Bladder Cancer

What is stage 2 bladder cancer?

Bladder cancer is a type of cancer that occurs in the bladder, which is a hollow organ in the lower part of the abdomen that stores urine. It is one of the most common types of cancer [¹], accounting for 4.2% of all cancers. Bladder cancer is often categorized into stages based on the extent of the cancer's spread. Stage 2 bladder cancer is a relatively early stage, but it still requires prompt treatment to prevent it from progressing further.

Stage 2 bladder cancer occurs when the cancer cells grow and spread into the muscle layer of the bladder wall. This is also known as invasive bladder cancer. In stage 2, the cancer has not yet spread beyond the bladder, but it is more advanced than stage 1 bladder cancer, where the cancer is confined to the inner lining of the bladder.

What are the subtypes of stage 2 bladder cancer?

Stage 2 bladder cancer is generally categorized as invasive bladder cancer, meaning that the cancer cells have grown into the muscle layer of the bladder wall. However, there are several subtypes of invasive bladder cancer, each with distinct characteristics and treatment options [²]. These subtypes include:

• Urothelial carcinoma: This is the most common subtype of bladder cancer, accounting for around 90% of cases [³]. It develops from the cells that line the inside of the bladder and can be further classified based on tumor grade (how abnormal the cells look under a microscope) and stage (how far the cancer has spread). These cancer cells are moderately differentiated in stage 2.
• Squamous cell carcinoma: This bladder cancer develops from the thin, flat cells that line the bladder. It is less common than urothelial carcinoma, accounting for around 4% of cases [⁴].
• Adenocarcinoma: This subtype of bladder cancer develops from glandular cells in the bladder that produce mucus. It is rare, accounting for less than 2% of cases [⁵].
• Small cell carcinoma: This is a rare and aggressive subtype of bladder cancer that develops from neuroendocrine cells in the bladder. It accounts for less than 1% of cases [⁶].
• Sarcomatoid carcinoma: This is another rare and aggressive subtype of bladder cancer that develops from connective tissue cells in the bladder. It accounts for less than 0.5% of cases [⁷].

Within stage 2, there are two subtypes that are distinguished by the extent of tumor invasion into the bladder lining:

• Stage 2a cancer: In this subtype, the cancer cells have invaded the bladder's inner lining (the lamina propria) but have not spread beyond it.
• Stage 2b cancer: In cancer stage 2b, the cancer cells have invaded the layer of connective tissue just below the inner lining of the bladder (the muscularis propria) but have not yet spread to nearby lymph nodes or distant organs.

Identifying the subtype of bladder cancer is important, as each subtype may respond differently to treatment and have a different prognosis. Your doctor may perform a biopsy to determine the subtype of bladder cancer and develop a personalized treatment plan based on the specific characteristics of your cancer.

Stage 2 bladder cancer staging and diagnosis

Bladder cancer staging

Bladder cancer is staged using the American Joint Committee on Cancer (AJCC) TNM system [⁸] for cancer to allow doctors and the cancer care team to assess how far cancer has spread. In general, the TNM system is used to describe and classify cancers, including {cancer type}, where:

• T (tumor) describes the size and location of the tumor and can either be TX (no information), T0 (no evidence), Tis (the pre-cancer stage where cancer is growing in the tissue it was found), and any number between one to four after the T (The higher the number, the bigger the tumor or, the more it has spread).
• N (nodes) indicates whether it has spread to nearby lymph nodes and can either be NX (no information about nearby lymph nodes), N0 (no cancer in nearby lymph nodes), or any number between one to four after N (the higher the number, the bigger the tumor or, the more it has spread to nearby lymph nodes).
• M (metastasis) describes if and how far the cancer has spread from its origin and can either be M0 (the cancer did not spread) or M1) the cancer has spread to distant organs.

How common is stage 2 bladder cancer?

According to the American Cancer Society, an estimated 82,000 new cases of bladder cancer are diagnosed each year in the United States alone. Moreover, the risk of developing cancer is one in 28 for men and one in 91 for women [⁹].

According to the National Cancer institute's Surveillance, Epidemiology, and End Result (SEER) program, Bladder cancer is the sixth most common type of cancer. It is mainly diagnosed in people aged 65-74, with a median age at diagnosis being 73 [¹⁰]. Moreover, almost 33% of all bladder cancers are diagnosed at the early stages [¹¹].

How is stage 2 bladder cancer diagnosed?

Several steps go towards an accurate diagnosis of bladder stage two cancer. Some of the most common diagnostic tests for bladder stage-two cancer include:

• Medical history and physical examination

The first step in diagnosing bladder cancer is a medical history and physical examination. During the medical history, the doctor will ask about the patient's symptoms, medical history, and any family history of cancer. The doctor will also perform a physical examination, which includes a pelvic exam for women and a rectal exam for men. The doctor will check for any lumps or abnormalities in the bladder area [¹²].

• Urine tests

The next step in diagnosing bladder cancer is a urine test. The doctor will collect a urine sample and send it to a laboratory for analysis. The laboratory will check the urine for the presence of blood, which is a common symptom of bladder cancer. The laboratory may also check the urine for other abnormalities [¹³].

• Imaging tests

Imaging tests look for abnormalities in the bladder and surrounding tissues. A CT scan is the most common imaging test used to diagnose bladder cancer. A CT scan is an X-ray that takes multiple pictures of the bladder and surrounding tissues [¹⁴].

• Cystoscopy

A cystoscopy is a procedure in which a small tube with a camera is inserted into the bladder through the urethra. The camera allows the doctor to see inside the bladder and look for abnormalities [¹⁵]. During the procedure, the doctor may also take a biopsy, which involves removing a small piece of tissue from the bladder for further analysis.

• Biopsy

A biopsy is a procedure in which a small piece of tissue is removed from the bladder and sent to a laboratory for analysis. The laboratory will examine the tissue under a microscope to look for the presence of cancer cells [¹⁶].

Stage 2 bladder cancer symptoms

Bladder cancer often begins with minor symptoms that may be easy to dismiss, but as the cancer progresses, the symptoms become more pronounced [¹⁷]. The stage 2 cancer symptoms can vary from person to person but may include the following:

• Blood in urine: Blood in the urine is the most common symptom of bladder cancer. This may not be visible to the naked eye and may only be detected by a urine test.
• Painful or burning sensation during urination: This is a common symptom of bladder cancer that occurs due to irritation of the bladder lining.
• Frequent urination: The urge to urinate frequently may increase as the cancer progresses.
• The urgency to urinate: The need to urinate may become more urgent as the cancer progresses.
• Lower back pain: This can occur as the cancer spreads to nearby tissues and organs.
• Pelvic pain: Pain or discomfort in the pelvic area can occur as the cancer grows and affects nearby tissues and organs.
• Swelling in the legs: This can occur when the cancer spreads to the lymph nodes and affects the body's ability to filter fluids.

It is important to note that other conditions may also cause these symptoms; having any symptoms does not necessarily mean a person has bladder cancer. However, if you experience these symptoms, you must speak with your doctor as soon as possible to rule out bladder cancer or any other serious medical condition. Early detection and treatment of tumor can improve the chances of a successful level of treatment and a positive outcome.

Stage 2 bladder cancer treatment

Stage 2 bladder cancer primary/first-line treatment

Fortunately, bladder cancer is among some of the most effectively treatable cancers. The primary treatment for stage 2 bladder cancer typically involves surgery to remove the cancerous tissue. This is usually done through transurethral resection of bladder tumor (TURBT) [¹⁸], which involves using a cystoscope to remove the cancerous tissue from the bladder wall. In some cases, a partial cystectomy (removal of a bladder portion) may also be performed.

After surgery, the patient may also receive additional treatment to reduce the risk of recurrences, such as intravesical therapy or chemotherapy. Intravesical therapy involves the administration of a medication directly into the bladder to kill any remaining cancer cells. This commonly includes a Bacillus Calmette-Guerin (BCG) medication that may be injected to reduce the risk of relapse in cases with a high risk of recurrence [¹⁹]. Chemotherapy involves the use of drugs to kill cancer cells throughout the body.

In some cases, radiation therapy may be used as a primary treatment for stage 2 bladder cancer. This involves using high-energy radiation to kill cancer cells in the bladder.

Other types of treatment for stage 2 bladder cancer

The choice of treatment for stage 2 bladder cancer may depend on several factors, including the size and location of the tumor, tumor grades, the patient's age and overall health, and any other medical conditions. Discussing all treatment options with a healthcare provider to determine the best course of action is important.

• Intravesical Therapy

Intravesical therapy is a type of treatment that involves the administration of a medication directly into the bladder through a catheter. This type of treatment is typically used after surgery to reduce the risk of the cancer returning [²⁰]. The medication used in intravesical therapy may be a chemotherapy drug or an immunotherapy drug.

• Chemotherapy

Chemotherapy is a type of treatment involving drugs to kill cancer cells throughout the body. Chemotherapy may be given before or after surgery or used as the primary treatment for bladder cancer that has spread beyond the bladder [²¹]. Chemotherapy can be given orally or intravenously, and the cancer treatment timeline can vary. Sometimes, doctors would recommend getting chemo and radiation at the same time for treatment of the second stage of bladder cancer. However, chemo and radiation therapy is often linked with secondary malignant neoplasm.

• Radiation Therapy

Radiation therapy is a type of treatment that involves the use of high-energy radiation to kill cancer cells. It may be combined with other treatments, such as chemotherapy, or it may be used as the primary treatment for bladder cancer that surgery cannot remove [²²]. However, radiation therapy can lead to secondary malignancies.

• Immunotherapy

Immunotherapy is a treatment that uses the body's immune system to fight cancer. It may be used to treat bladder cancer that has spread beyond the bladder or to reduce the risk of the cancer returning after surgery [²³]. Immunotherapy drugs may be given intravenously or through a catheter into the bladder.

• Targeted Therapy

Targeted therapy involves the use of medication that targets specific molecules or genes of cancer cells. Targeted therapy may treat bladder cancer that has spread beyond the bladder or reduce the risk of the cancer returning after surgery [²⁴].

Is Stage 2 cancer curable?

Stage 2 bladder cancer can be treated and is one of the few curable cancers, but the success of treatment depends on several factors.

The chances of a cure for stage 2 bladder cancer depend on the type of cancer, the size of tumors, and location of the tumor, whether the cancer has spread to other parts of the body, and the patient's overall health.

Surgery to remove the cancerous tissue, along with additional treatment such as immunotherapy, can effectively treat grade 2 cancer and achieve a cure [²⁵]. Moreover, several advances are being made in the medical industry to find a possible cure for stage 2 bladder cancer [²⁶]. Moreover, stage 2 cancer life expectancy is higher than most average cancers.

Prognosis: Stage 2 bladder cancer survival rate

Stage 2 bladder cancer survival rate

The five-year relative stage 2 cancer survival rate is around 77%. This means that more than 77 out of hundred patients will survive the first five years of diagnosis [¹⁰]. However, the earlier the cancer is caught, the better the chances of survival. For example, there is a 69.6% cancer stage 2 survival rate for stage 2 bladder cancer but only a 5-7% cancer survival rate for advanced stages.

Moreover, several factors can affect the survival rate [²⁷]. Some of these factors include:

• Age: Generally, reports found that younger people have a better chance of survival than older people [²⁸].
• Overall health: People in good overall health tend to have a better chance of survival than those in poor health.
• Treatment options: The treatment options for the type of cancer can also affect survival rates. Some cancers are more responsive to certain treatments than others [²⁹].
• Response to treatment: How well an individual responds to treatment can also affect their survival rate. If the cancer responds well to treatment, the chances of survival are higher.

Stage 2 bladder cancer recurrence rate

Despite effective treatment, there are relatively high chances of recurrence in stage 2 bladder cancer. Since the cancer has invaded the muscle layer, it has a high rate of progression, and patients have a 40-54% chance of recurrence [³⁰]. Moreover, it is challenging to accurately predict the recurrence time, as it can vary between five, ten, and 15 years after treatment [³¹] [³²].

Stage 2 cancer growth rate

Several factors can affect the rate of recurrence and progression of bladder cancer. For example, smoking can increase the rate of progression of early-stage cancer by four times [³³]. Generally, one in three bladder cancers spread into the deeper layers, and 5% of cancers metastasize [³⁴].

Lifestyle changes for preventing and managing bladder cancer

While there is no guaranteed way to prevent bladder cancer, several lifestyle changes can help reduce the risk of developing or managing the disease for those who have already been diagnosed.

• Quit Smoking

Smoking is a leading risk factor for bladder cancer [³⁵]. The chemicals found in tobacco smoke can enter the bloodstream and travel to the bladder, damaging the lining and increasing the risk of cancer. If you smoke, quitting is one of the most effective ways to reduce your risk of bladder cancer.

• Eat a Healthy Diet

A diet high in fruits, vegetables, whole grains, and lean protein can help reduce the risk of bladder cancer [³⁶]. Additionally, certain foods and drinks, such as processed meats, fried foods, and sugary drinks, should be limited or avoided [³⁷].

• Exercise Regularly

Regular exercise can help maintain a healthy weight and reduce the risk of several types of cancer, including bladder cancer [³⁸].

• Practice Good Hygiene

Poor hygiene habits can increase the risk of bladder infections, which can, in turn, increase the risk of bladder cancer [³⁹]. Practice good hygiene habits, such as washing your hands regularly and wiping front to back after using the bathroom.

• Manage Chronic Conditions

Certain chronic conditions, such as diabetes and obesity [⁴⁰] [⁴¹], can increase the risk of bladder cancer. If necessary, managing these conditions through lifestyle changes and medication can help reduce the risk of developing bladder cancer.

• Get Screened

Regular screening tests can help detect bladder cancer early when it is most treatable. If you are at high risk for bladder cancer, such as if you have a family history of the disease or have been exposed to certain chemicals at work, talk to your doctor about the appropriate screening tests.

Takeaway

The key takeaway for those with stage 2 bladder cancer is that early detection and treatment can greatly increase the chances of a successful outcome. If you experience any symptoms of bladder cancer, be sure to talk to your doctor immediately. Additionally, staying informed about the disease and its treatment options can help you make informed decisions about your healthcare and improve your overall quality of life. Finally, taking steps to maintain a healthy lifestyle, such as quitting smoking, eating a healthy diet, and getting regular exercise, may help reduce your risk of developing bladder cancer in the first place.