Overview

Papillary urothelial carcinoma is a type of bladder cancer. It starts in urothelial cells in the bladder lining. Urothelial cells also line the urethra, ureters, and other parts of the urinary tract. Cancer can start in these areas, too.

Papillary tumors are thin, finger-like growths that 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 cancer can spread to other organs.

Types and stages

A 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 normal 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.

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 inner lining of the bladder. 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 it 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 in a man, or into the uterus and vagina in a woman. It has not spread to the lymph nodes or other organs.

Stage 4: The cancer may have spread to lymph nodes and other parts of the body.

Symptoms

Symptoms of this type of bladder cancer include:

  • blood in the urine
  • an urgent need to urinate
  • needing to urinate more often than usual
  • 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

Causes

Causes of urothelial cancers include:

Smoking: Cigarette smoking is the leading cause of all bladder cancers, including urothelial cancers. If you smoke, you’re about three times as likely to get bladder cancer as someone who doesn’t smoke.

Chemical exposure: Being exposed 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 that have been linked to bladder cancer.

Medicines 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 it hasn’t been proven to cause 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: 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

How is it treated and managed?

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 called Bacillus Calmette-Guerin (BCG). These germs alert your immune system, which attacks the bladder cancer cells. Chemotherapy uses chemicals to kill cancer cells.

Stage 2

Stage 2 cancers are treated with a partial or total cystectomy, depending how deep into the bladder the cancer has grown. Partial cystectomy removes the part of the bladder where the cancer is located. Total cystectomy removes the whole bladder. Nearby lymph nodes may be removed, too.

You may get chemotherapy before or after the surgery to prevent the 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.

Prognosis and life expectancy

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 they’ve been treated.

Survival rates

Five-year survival rates for all types of bladder cancer are:

  • Stage 0: 98 percent
  • Stage 1: 88 percent
  • Stage 2: 63 percent
  • Stage 3: 46 percent
  • Stage 4: 15 percent

These survival rates include all kinds of bladder cancer, not just papillary tumors. They’re also only estimates. They can’t predict what your outlook will be.

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

Outlook

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

If you have a 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.