Papillary urothelial carcinoma: A type of bladder cancer
The bladder is a muscular organ in the pelvis that stores urine. Bladder cancer develops when abnormal cells in the bladder grow too quickly.
A person who receives a diagnosis of bladder cancer in the earliest stage, before it has started to spread, has a 95% chance of living for at least another 5 years.
In this article, we investigate the symptoms, causes, and treatment options for papillary urothelial carcinoma.
What is papillary urothelial carcinoma?
Papillary urothelial carcinoma is often easier to treat than other types of bladder cancer.
Bladder cancer can develop in any layer of the bladder walls.
Papillary urothelial carcinoma begins by affecting the urothelial cells within the bladder or the lower parts of the kidneys, where urine pools before moving on to the bladder through the ureters.
Papillary urothelial carcinoma tumors have a shape like a small mushroom. They attach with a tiny stem to the inner layer of the bladder, lower kidney, or ureter.
The American Cancer Society describe the tumors as "finger-like," adding that these projections tend to grow toward the center of the bladder, without affecting the deeper layers of the bladder walls.
Sometimes these tumors do not spread. Due to the way that this type of cancer forms and grows, it tends to be fairly easy to treat, and it has a good prognosis.
What does identifying and treating kidney cancer involve? Find out here.
Symptoms of papillary urothelial carcinoma are similar to those of other types of bladder cancer.
They can include:
- bladder irritation
- changes in urination habits
- needing to urinate without being able to
- pain, if a blockage develops
- blood in the urine
If papillary urothelial carcinoma spreads, there may be other symptoms, including:
Learn more about urinary urgency and what can cause it.
About bladder cancer
Bladder cancer can affect any part of the bladder. There are also bladder cells outside of the organ itself, in other parts of the urinary tract. As a result, bladder cancer can develop in parts of the kidneys, ureters, and urethra.
There are many kinds of bladder cancer, but the three most common are:
Urothelial carcinoma: This accounts for around 90% of bladder cancer cases.
Squamous cell carcinoma: These cancerous cells can develop as a result of bladder irritation. Around 4% of bladder cancers are this type.
Adenocarcinoma: This develops within glandular cells, and it accounts for around 2% of bladder cancer cases.
During diagnosis, a doctor will classify the cancer by its type and stage.
Doctors classify bladder cancer by type and stage, which indicates how far the cancer has spread.
The stages of bladder cancer are:
Stage 0: The cancer is on the surface of the lining. It has developed recently, it is easy to remove, and it has not started to spread. Doctors call this type of cancer "in situ."
Stage 1: The cancer has spread to the inner layer of the lining, but not the bladder muscle. It is "localized."
Stage 2: The cancer has spread to the muscle. It is "regional."
Stage 3: The cancer has spread from the muscle to nearby tissues and possibly a lymph node. This is also considered "regional."
Stage 4: The cancer has spread to other areas of the body. Doctors may call this "distant" or "metastatic" cancer.
According to experts, 10–15% of people with superficial bladder cancer, including papillary tumors, will develop invasive or metastatic cancer.
Bladder cancer can also be high or low grade.
A low grade tumor contains cells that appear similar to healthy cells. They tend to grow more slowly and are less likely to spread than those in high grade tumors. In-situ tumors are low grade.
A high grade tumor contains cells with an abnormal appearance. The tumor is likely to spread to the muscle and neighboring tissues.
Causes and risk factors
The likelihood of developing bladder cancer, including papillary urothelial carcinoma, increases with exposure to certain risk factors.
- using tobacco products
- taking the diabetes drug pioglitazone (Actos)
- taking dietary supplements that contain aristolochic acid
- taking the chemotherapy drug cyclophosphamide (Cytoxan) in the long term
- undergoing radiation therapy
- exposure to arsenic, which is present in drinking water in some parts of the world
- exposure to chemicals, including some used in printing and rubber, leather, textile, and paint manufacturing, as well as in hair dyes and diesel fumes
Other factors that may increase the risk include:
Low water consumption: This can reduce the rate at which the body flushes out chemicals.
Age: The risk of developing bladder cancer is higher after the age of 65.
Sex: It is more common in males than in females.
Race and ethnicity: White people are more likely to develop bladder cancer than others.
History of bladder problems: Urinary tract infections, bladder stones, catheter use, and other sources of bladder irritation may increase the risk.
History of bladder cancer: Someone who has already had bladder cancer may have an increased risk of developing it again.
Genetic factors: A person with a family history of bladder cancer has a higher risk of developing it. Also, having Lynch syndrome, Cowden syndrome, or retinoblastoma — all of which involve genetic mutations —can increase the risk.
Birth abnormalities: Those who are born with a bladder problem may have a higher risk of developing cancer in the area.
Other conditions: Schistosomiasis, also known as bilharziasis, is an infection caused by a parasitic worm, and it can also increase the risk.
Surgery is a possible treatment for papillary urothelial carcinoma.
Treatment of papillary urothelial carcinoma will depend on several factors, including:
- the person's overall health
- the stage of cancer
- the grade of cancer
- personal preferences
A person should discuss options thoroughly with the doctor before deciding on the best course of treatment.
The doctor may recommend one or a combination of the following treatments:
Transurethral resection of the tumor is a common surgery for noninvasive papillary urothelial carcinoma.
A surgeon will insert a small camera with a tool to cut or burn away the tumor. They will also collect some tissue for analysis. If cancerous cells have not spread beyond a small area, the person may not need further treatment.
If it is likely that some cancerous cells are still present after surgery, the doctor may prescribe chemotherapy. This involves using powerful drugs to kill cancerous cells, but the drugs also affect healthy cells. Side effects include fatigue, nausea, and a weakened immune system.
Learn more about chemotherapy.
This can help the immune system recognize and fight cancer. In some cases, immunotherapy may be enough to treat papillary tumors. Or, the doctor may recommend a combination of it and chemotherapy, surgery, or all three.
This involves using powerful rays to shrink a cancerous tumor. It is not usually the first choice for this type of cancer, but a doctor may prescribe it alongside other treatments.
Papillary urothelial carcinoma is often slow growing, and it tends to respond well to treatment. This increases the likelihood of a favorable outcome.
The American Cancer Society use statistics to estimate a person's chance of living for at least another 5 years after diagnosis. For bladder cancer in general, the survival rate estimates are:
- In situ: 95%
- Localized: 69%
- Regional: 35%
- Distant: 5%
- Overall: 77%
According to the National Cancer Institute, 70–80% of people with diagnosed bladder cancer receive the diagnosis while the tumor is still superficial, or in situ.
The prognosis also depends on the grade of the tumor. People with lower grade tumors have a better outlook than those with higher grade tumors.
However, various factors affect the outlook for each individual, including their age and the type of cancer that they have. Each person's experience will be different.
Medical progress is ongoing, and cancer survival rates continue to improve.
Not all tumors are cancerous. Find out more about the different types and associated risks.
How does someone know when to see a doctor about papillary urothelial carcinoma? I have a lot of urinary tract infections. Should I ask for screening?
Urinary tract infections are common, and most are not associated with long term complications. Doctors do not recommend routine screening for bladder cancer.
However, if you have recurrent urinary tract infections, you can ask your doctor if you may have a higher risk of bladder cancer and, if so, what they would recommend. If you also have other bladder cancer risk factors or symptoms, it’s best to get checked out by a doctor.Yamini Ranchod, PhD, MS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.