Bladder Cancer (cont.)

The most important factors that impact the prognosis (or the chances of control and cure) of bladder cancer are the stage and grade of the tumor. The lower the stage and grade, the better the outlook. Other factors such as number, size, pattern of recurrence (if any), response to initial treatment like BCG, coexistent carcinoma in situ, and certain genetic mutations also play a role.

For low-risk superficial bladder cancer (Ta, low grade), the chances of recurrence are about 15% in one year and 32% in five years after the initial diagnosis. This necessitates regular follow-up, even in these low-risk tumors. However, unlike the more aggressive variants of bladder cancer, the chances of progression (for example, chances of the tumor invading into the deeper layers of the bladder) are less than 1%. Typically, these tumors, even when they recur, do so in the same stage and grade as the original tumor and do not compromise the life expectancy of the patient.

High-risk superficial tumors are those that are high grade, T1 tumors, and/or are associated with extensive areas of carcinoma in situ. Multiple tumors, large tumors, and those that recur despite BCG treatment are also at an increased risk for recurrence and progression. These tumors have a recurrence rate in the range of 61%-78% at one and five years respectively. They are also much likely to invade into the deeper layers with progression rates of 17%-45% at one and five years. These tumors need to be managed and followed up more aggressively since they have a potential to invade and spread to other parts of the body thereby shortening the life expectancy of the patient.

After radical cystectomy, survival depends mostly on the stage of the disease. The five-year disease specific survival for various stages after a radical cystectomy is as follows.

• T2, N0: 70%-80%



• T3, N0: 40%-50%



• T4, N0: 25%-30%



• N+ (patients with lymph node involvement): 15%-20%

Five-year survival is rare in patients with metastatic disease despite chemotherapy. It is important to note that these are statistics compiled for large groups of patients. Every individual patient is different from the others and may have outcomes starkly different from those mentioned in the average analysis above.

Source: MedicineNet.com
http://www.medicinenet.com/bladder_cancer/article.htm