Prognosis and survival for bladder cancer

If you have bladder cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognostic factor is an aspect of the cancer or a characteristic of the person (such as age and if they smoke) that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic and predictive factors for bladder cancer.

How deep the tumour has grown into the wall of the bladder is an important prognostic factor. The deeper the tumour has grown into the bladder wall, the less favourable the prognosis.

Advanced stages of bladder cancer that have spread beyond the bladder into lymph nodes or other parts of the body have a poorer prognosis than early stages.

Low-grade bladder cancers do not usually grow into the muscle layer of the bladder wall and do not usually spread to other parts of the body. Because of this, low-grade bladder cancers tend to have a good prognosis. High-grade bladder cancers have a greater risk of spreading and a poorer prognosis.

Tumours that are only on the surface of the inner bladder lining (superficial tumours) are usually well differentiated. This means the cancer cells look much like normal bladder cells. These tumours have a good prognosis.

Having carcinoma in situ (CIS) in the bladder is associated with a less favourable prognosis. It is more likely to come back (recur) after treatment. There is also a greater risk of CIS developing into invasive bladder cancer.

The prognosis is different for each type of bladder cancer. Papillary urothelial carcinomas of the bladder have the best prognosis. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma of the bladder tend to have a poor prognosis. They are usually invasive and diagnosed at a later stage.

People with multiple tumours in the bladder or urinary tract have a higher risk that cancer will come back (recur) compared to those with only one tumour. The more tumours or areas with cancer, the less favourable the prognosis.

People with smaller bladder tumours have a better prognosis than people with large tumours.

Bladder cancer that comes back after treatment (a recurrence) has a poorer prognosis than bladder cancer that happens for the first time (a primary tumour). The more recurrences, the poorer the prognosis.

Non-invasive bladder cancer that comes back soon (a few months) after treatment tends to have a less favourable prognosis than a cancer that comes back long after treatment (many years later).

If bladder cancer has moved into small lymph vessels or blood vessels (called lymphovascular invasion, or LVI) or into lymph nodes around the bladder, the prognosis is poorer. These cancers have a much higher risk of spreading to other parts of the body.