Papillary Urothelial Carcinoma

Papillary tumors are thin, finger-like growths that usually start in the bladder lining and extend into the center of the bladder.

Sometimes, these cancers stay in the bladder without growing or spreading. But more aggressive types of this bladder cancer can spread to other organs.

Papillary tumors can also develop in other body parts, such as the thyroid or the breast. These tumors are not always cancer. Some papillary tumors can be benign.

A cancerous papillary tumor can be noninvasive or invasive. Noninvasive cancers are only in the inner bladder layer. They haven’t reached the deeper layers of the bladder or spread to other organs.

Invasive tumors have grown into the deeper layers of the bladder. They’re more likely to spread.

Papillary tumors can also be low grade or high grade. Low grade tumors look more like typical cells and tend to grow slowly. High grade cancer cells look more abnormal and can grow quickly.

Based on these categories, papillary tumors of the bladder are divided into four types:

• Papilloma: This is a noncancerous tumor growing out of the bladder lining.
• Papillary urothelial neoplasm of low malignant potential (PUNLMP): This is a precancerous growth. It’s not likely to grow and spread.
• Low grade papillary urothelial carcinoma: These tumors tend to grow slowly, but they can come back after treatment.
• High grade papillary urothelial carcinoma: These tumors grow more quickly and are more likely to spread.

Because PUNLMPs and low grade papillary urothelial carcinomas are very similar, with comparable molecular genetic alterations and instances of recurrence, there is some controversy over whether these two types should be considered different types of cancer.

Stages

Bladder cancer is staged based on how aggressive it is and where it has spread.

• Stage 0a: This is also called noninvasive papillary urothelial carcinoma. This early stage, noninvasive cancer is only found in the bladder’s inner lining. It hasn’t grown into the muscle or connective tissue of the bladder wall.
• Stage 1: The cancer has grown into the inner bladder lining but has not reached the muscle in the bladder wall.
• Stage 2: The cancer has spread into the bladder muscle. Now it’s considered invasive cancer. However, stage 2 cancer has not spread to the lymph nodes.
• Stage 3: The cancer has spread into the layer of tissue around the bladder. It may have spread to the prostate or into the uterus and vagina. It has not spread to the lymph nodes or other organs.
• Stage 4: The cancer may have spread to lymph nodes and other body parts.

Symptoms of this type of bladder cancer include:

• blood in the urine
• an urgent need to urinate
• needing to urinate more often than usual, including waking up multiple times in the night to urinate
• pain when you urinate

When the cancer spreads, symptoms can include:

• loss of appetite
• weight loss
• lower back pain
• night sweats
• fatigue
• weakness
• fever
• swelling in the feet
• not being able to urinate

Causes of urothelial cancers include:

• Smoking: Cigarette smoking is the leading cause of all bladder cancers, including urothelial cancers. Those who smoke are about three times as likely to get bladder cancer as those who don’t smoke.
• Chemical exposure: Exposure to certain chemicals at work can increase your risk. People who work in the rubber, textile, paint, printing, and dye industries may be exposed to various chemicals linked to bladder cancer.
• Medications and supplements: Overusing pain relievers containing phenacetin may increase your risk of this cancer. Herbal supplements containing aristolochic acid might also increase your risk.
• Chronic bladder infections or irritation: Having repeated urinary tract infections or stones has been linked to bladder cancer, although there’s no proof that it causes this cancer.
• Family history: Some bladder cancers run in families. Urothelial cancer is more common in families with Lynch syndrome, an inherited condition that makes people more likely to get several types of cancer.

Other factors that can lead to papillary urothelial carcinoma include:

• arsenic exposure
• certain genetic mutations
• previous treatment with certain chemotherapy drugs, such as cyclophosphamide
• previous pelvic radiation

The treatment you get depends on the stage of your cancer.

Stage 0

Noninvasive papillary carcinoma is often treated with a procedure called transurethral resection of bladder tumors (TURBT). The surgeon places an instrument up your urethra into your bladder and removes any abnormal tissue.

Stage 1

Stage 1 cancers are treated with TURBT followed by intravesical therapy. During intravesical therapy, the doctor places a catheter into your bladder to deliver medication straight into your bladder. You can get immunotherapy or chemotherapy this way.

Immunotherapy uses a type of bacteria-based drug called Bacillus Calmette-Guerin (BCG). These germs alert your immune system, which attacks bladder cancer cells. Chemotherapy uses chemicals to kill cancer cells.

Stage 2

Stage 2 cancers are treated with a partial or total cystectomy, depending on how deep cancer has grown into the bladder.

A partial cystectomy removes the area of the bladder where the cancer is located. A total cystectomy removes the whole bladder. Nearby lymph nodes may be removed, too.

You may get chemotherapy before or after the surgery to prevent cancer from coming back.

Stage 3

Treatment includes partial or total cystectomy, along with chemotherapy. Radiation and immunotherapy may be options, as well.

Stage 4

Chemotherapy is the main treatment for stage 4 cancer. You might also get radiation or immunotherapy. Surgery may also be an option.

In general, papillary urothelial cancers have a better prognosis than other types of bladder cancer. Your specific outlook depends on the stage and grade of your cancer.

High grade cancers can spread. Low grade papillary cancers are less likely to spread. Papillary cancers can also return after treatment.

Survival rates

Relative survival rates for bladder cancer include all types of this cancer, not just papillary tumors. They are only estimates and can’t predict what your outlook will be.

These estimates are based on information from the SEER database that the National Cancer Institute maintains. Instead of grouping cancers by numbered stages, it groups them into the following stages:

• In situ alone: The cancer is present in bladder cells but hasn’t yet spread to adjacent tissues.
• Localized: The cancer hasn’t spread beyond the bladder.
• Regional: The cancer has spread to nearby lymph nodes or structures.
• Distant: The cancer has spread to the lungs, liver, bones, or other distant body parts.

Based on diagnoses between 2011 and 2017, the 5-year relative survival rates for all types of bladder cancer are:

Diagnosing bladder cancer early will give you the best odds of survival.

Urothelial carcinoma is the most common type of bladder cancer in the United States. It develops in the bladder’s urothelial cells.

The less common types of bladder cancer are:

• Squamous cell carcinoma: These cells are similar to the thin, flat cells on the skin’s surface. They may form after a long lasting infection or irritation. Most of these cancers are invasive.
• Adenocarcinoma: This cancer develops in mucus-producing glandular cells in the bladder’s lining. Most of these cancers are invasive.
• Small cell carcinoma: This type of cancer develops in the bladder’s neuroendocrine cells. It is aggressive and usually treated using chemotherapy.
• Sarcoma: This aggressive type of cancer develops in the bladder’s muscle cells.

The following are the answers to some common questions about papillary urothelial carcinoma.

What is the life expectancy for people with papillary urothelial carcinoma?

If papillary urothelial carcinoma is diagnosed before it spreads beyond the bladder, there is a 70% chance of living for at least another 5 years.

However, if cancer has spread to distant organs such as the lungs or liver, there is a 6% 5-year survival rate.

How aggressive is papillary urothelial carcinoma?

Papillary urothelial carcinoma often has a slow growth rate compared to less common types of bladder cancer.

Because papillary carcinomas tend to grow slowly toward the center of the bladder and don’t invade deeper layers, the prognosis is usually positive.

Can papillary urothelial carcinoma be cured?

Stage 0a (noninvasive) papillary urothelial carcinoma may be cured without treatment. Later stages, however, are less likely to be cured.

Bladder cancer, including noninvasive papillary urothelial carcinoma, tends to return after the removal of the tumor. The recurring tumors may develop in other areas of the bladder.

Your outlook depends on the stage of your cancer. Early stage papillary urothelial cancers have an excellent prognosis and high survival rates. Late stage, invasive cancers may be harder to treat.

If you have late stage cancer and you’ve exhausted your treatment options, you might consider enrolling in a clinical trial. These trials test out new treatments for cancer before they’re available to the public. Ask your doctor if a clinical trial is right for you.

Papillary urothelial carcinoma is the most common type of bladder cancer in the U.S. This slow-growing cancer may remain in the bladder or spread to other organs.

Cigarette smoking is a leading cause of papillary urothelial carcinoma. Early symptoms may include blood in your urine or an urgent need to urinate.

Treatment may involve removing abnormal tissue, immunotherapy, chemotherapy, or a cystectomy depending on the cancer stage. Noninvasive papillary urothelial carcinoma may return after the removal of a tumor.

The earlier papillary urothelial carcinoma is diagnosed, the more positive the prognosis may be.