Types of bladder cancer

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This refers to what it looks like down a microscope and includes the histological type and the histological grade. These factors in combination with how advanced the tumour has grown (stage), the general condition of the patient, determine the prognosis (likely outcome) and the best modality of treatment for that individual.

Histological type - There are three types of bladder cancer that start in the lining of the bladder depending on the cells that become cancerous:

• Transitional cell carcinoma: Malignancy that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied.
• Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells which have only formed in the bladder after long-term infection or irritation from, for example a stone.
• Adenocarcinoma: Cancer that begins in glandular (secretory) cells  and are often in the uppermost aspect of the bladder within an embryonic remnant  which, as a foetus connected to the bladder to belly button.

Histological grade - The pathologist will determine the aggressiveness or grade of the tumour by comparing the microscopic features of the surgical specimen with an established classification system. In general these systems look at:

How the pattern of cells within the tumour looks the organ of origin - if a low grade (often otherwise called grade 1, or well differentiated) tumour will have features, albeit disrupted, of it origin. If high grade (grade 3 or poorly differentiated) will just look like a sheet of cells with no residual distinctive pattern remaining.

How aggressive the cancer cells look like. If the cells are large, show features of dividing rapidly or are very dissimilar to those from its organ of origin they are usually classed as high grade. If small, look like they are they are not dividing rapidly and look similar to those from its origin they are usually be classed as low grade.

Often more advanced test are performed at this stage by the pathologist using special stains or process picking up receptors on the cell surface or nucleus called immunohistochemistry. A good example of these or oestrogen or HER2  receptors for breast cancer but similar less known immunohistochemical tests can be used for a wide range of cancers.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.