non-invasive bladder urothelial carcinoma

Non-invasive bladder urothelial carcinoma, also known as non-muscle invasive bladder cancer (NMIBC), refers to a type of cancer that affects the inner lining of the bladder. The cancer cells are confined to the epithelium, which is the thin layer of cells that lines the inside of the bladder.

• Characteristics: Non-invasive bladder urothelial carcinoma is typically characterized by tumors that are small in size and have not grown through the inner lining into the muscle wall of the bladder [3][6].
• Types: There are two main types of non-invasive papillary urothelial carcinomas: low-grade (LGPUC) and high-grade (HGPUC). Low-grade tumors have cells that look slightly abnormal, while high-grade tumors have cells that look very abnormal [1].
• Risk: While these tumors rarely become invasive, they are more likely to come back after treatment [1]. Risk-adapted treatment is essential to balance adverse effects of treatment with adequate disease control [2].

Non-invasive bladder urothelial carcinoma accounts for the majority of bladder cancer cases and has a relatively good prognosis compared to invasive forms. The early-stage diagnosis offers patients the best chance to eliminate cancer cells before they spread beyond the bladder [8].

Common Signs and Symptoms of Non-Invasive Bladder Urothelial Carcinoma

Non-invasive bladder urothelial carcinoma, also known as non-muscle invasive bladder cancer (NMIBC), is a type of bladder cancer that has not yet grown deep enough to reach the main muscle layer of the bladder wall. While symptoms may vary from person to person, there are some common signs and symptoms associated with this condition.

• Blood in urine: One of the most common symptoms of non-invasive bladder urothelial carcinoma is blood in the urine (hematuria). This can be painless or painful, and the blood may appear bright red, cola-colored, or even normal in color. [8][9]
• Frequent urination: People with NMIBC may experience a frequent need to pass urine, which can be accompanied by a sensation of incomplete emptying. [8]
• Burning or irritation during urination: Some individuals may feel burning or irritation while urinating, which can be a sign of bladder cancer. [7][8]
• Increased urge to urinate: A sudden increase in the need to urinate, even when the bladder is not full, can also be a symptom of non-invasive bladder urothelial carcinoma. [7]

It's essential to note that these symptoms can be similar to those experienced by people with other non-cancerous conditions, such as urinary tract infections or kidney stones. Therefore, it's crucial to consult a healthcare professional for an accurate diagnosis and treatment plan.

References:

• [8] Context result 8: "Close to 30 percent of bladder cancer patients experience burning, frequent urination, or a sensation of incomplete emptying when they urinate."
• [9] Context result 9: "The most common symptom of bladder cancer is blood in the urine (haematuria), which usually occurs suddenly and is generally not painful."

Diagnostic Tests for Non-Invasive Bladder Urothelial Carcinoma

Non-invasive bladder urothelial carcinoma is a type of cancer that affects the lining of the bladder. Diagnosing this condition requires a combination of medical history, physical examination, and various diagnostic tests.

• Urine Cytology: This test involves examining voided urine to detect exfoliated urothelial cells. It is a non-invasive and highly specific test for diagnosing bladder cancer (8). Studies have shown that urine cytology can detect up to 97% of cases of urothelial carcinoma (7).
• Urinalysis: This test checks for blood and other substances in the urine, which can indicate the presence of bladder cancer. However, it is not specific for bladder cancer and can be affected by various factors such as urinary tract infections.
• Cystoscopy: This procedure involves using a cystoscope to visually examine the inside of the bladder. It can help identify tumors or lesions on the bladder wall (6).
• Imaging Studies: Imaging studies such as retrograde pyelogram and CT scans may be used to evaluate the extent of the cancer and rule out any spread to other parts of the body.
• Liquid Biopsy: This is a non-invasive test that involves analyzing urine or blood samples for genetic material from bladder cancer cells. It has shown promise in detecting bladder cancer at an early stage (2).

References

(1) Kassouf W, Black P. Treatment of primary non-muscle invasive urothelial bladder cancer. UpToDate. 2023.

(2) Introduction to Bladder Cancer. UpToDate. 2023.

(3) The type of bladder cancer that most patients are diagnosed with is urothelial carcinoma. There are other types of cancers of the bladder, like adenocarcinoma and squamous cell carcinoma.

(4) Clinical presentation, diagnosis, and staging of bladder cancer Epidemiology and risk factors of urothelial carcinoma of the bladder Evaluation of hematuria in adults Non-urothelial bladder cancer Pathology of bladder neoplasms Radical cystectomy Screening for bladder cancer Treatment of primary non-muscle invasive urothelial carcinoma of the ...

(5) The European Association of Urology guidelines on non–muscle-invasive bladder cancer present updated information on the diagnosis and treatment of this disease. Recent findings are provided for their routine application in clinical practice.

(6) Testing typically involves urinalysis to evaluate patients for hematuria, cystoscopy and/or imaging to investigate whether a lesion is present, and urine cytology to detect exfoliated urothelial cells.

(7) Studies have shown that urine cytology can detect up to 97% of cases of urothelial carcinoma.

(8) Urine cytology involves examining voided urine to detect exfoliated urothelial cells. It is a non-invasive and highly specific test for diagnosing bladder cancer.

(9) Testing typically involves urinalysis to evaluate patients for hematuria, cystoscopy and/or imaging to investigate whether a lesion is present, and urine cytology to detect exfoliated urothelial cells.

(10) Early testing for bladder cancer plays a pivotal role in the timely detection and treatment of this disease. By undergoing regular screenings and diagnostic procedures, individuals can increase their chances of detecting bladder cancer at an early stage when treatment options are most effective.

Treatment Options for Non-Invasive Bladder Urothelial Carcinoma

Non-invasive bladder urothelial carcinoma, also known as non-muscle invasive bladder cancer (NMIBC), is a type of cancer that affects the lining of the bladder. The main goal of treatment is to remove or destroy the cancer cells while preserving the function and structure of the bladder.

Treatment Options:

• Intravesical Therapy: This involves delivering medications directly into the bladder through a catheter. The most common types of intravesical therapy for NMIBC include:
  • BCG (Bacillus Calmette-Guerin) Therapy: A vaccine that stimulates the immune system to attack cancer cells [4].
  • Chemotherapy: Medications such as mitomycin C and gemcitabine are commonly used for intravesical therapy, usually given after initial TURBT (Transurethral Resection of Bladder Tumor) [8].
• Immunotherapy: This type of treatment uses medications to stimulate the immune system to attack cancer cells. Examples include:
  • Pembrolizumab (Keytruda): An immunotherapy that has been approved for use in NMIBC, especially for patients who have not responded to BCG therapy [3][9].
• Surgery: In some cases, surgery may be necessary to remove the cancerous tissue. However, this is usually reserved for more advanced or recurrent cases.

Recent Developments:

• The FDA has approved a two-drug combination of enfortumab vedotin and pembrolizumab (EV/pembro) for treating NMIBC [7].
• Anktiva (N-803), an immunotherapy-boosting drug, has been approved by the FDA to enhance the effectiveness of BCG therapy in patients with high-risk NMIBC [5].

References:

[1] Context 2 [3] Context 3 [4] Context 4 [5] Context 5 [7] Context 7 [8] Context 8 [9] Context 9

Based on the provided context, the differential diagnosis for non-invasive bladder urothelial carcinoma includes:

• Urothelial dysplasia and carcinoma in situ: These are precursor lesions that can progress to invasive cancer (1).
• Inverted papilloma of the bladder (IPB): This condition exhibits similar clinical symptoms and imaging presentations as bladder urothelial carcinoma (3, 4).
• Pseudosarcomatous myofibroblastic proliferations: These are benign or locally aggressive conditions that can be considered in the differential diagnosis (5).

It's also worth noting that the spectrum of urothelial bladder cancer at presentation includes non-muscle invasive, muscle invasive, and metastatic disease (8). Therefore, a thorough evaluation is necessary to determine the correct diagnosis.

References:

• [1] Urothelial dysplasia and carcinoma in situ are both precursor lesions of invasive cancer and associated with increased risk of disease progression and ...
• [3] Bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB) exhibit similar clinical symptoms and imaging presentations.
• [4] Bladder urothelial carcinoma (BUC) and inverted papilloma of the bladder (IPB) exhibit similar clinical symptoms and imaging presentations. 2.
• [5] The differential diagnosis includes benign or locally aggressive conditions, including pseudosarcomatous myofibroblastic proliferations ( ...