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Definition, please

10 years 5 months ago #32755 by mcw2670
Hi Sara-Anne
I am new to the list and new to bladder cancer also :(
In simple terms, Papillary transitional cell carcinoma Grade II-III/IV means a tumour on the inner surface of the bladder lining, which has not begun to invade the bladder wall, but does contain cells which have started to behave in an "aggressive" manner. In simple terms they have lost their respect for the cells around them and have begun to proliferate in a worrying manner.
Papillary tumours grow out from the inner wall of the bladder in feathery projections. The thickness of these projections is somewhat greater than the normal lining of the bladder (the urothelium). Low grade papillary tumours are easilly treated by resection (cutting out) but have a high rate of recurrence.
You also mention CIS (carcinoma in situ) ot TIS (Tumour in situ) which grows out flat, in the plane of the bladder lining. This form is generally more worrisome as it is by definition of higher grade and more likely to become invasive.

Bladder tumours are thought to arise from insults to the bladder (from smoking, dyes and other bladder toxins) and may appear many years or decades after the original insult.
It appears as though the lining of the bladder becomes reprogrammed by these insults and that it become more likely then to accumulate changes in the cells lining the bladder which predispose to cancer.
It is thought that the changes which occur in Papillary tumours are somewhat different to those which occur in CIS. This suggests that in folks with CIS and Pap, there are two distinct cell populations, with two distinct sets of genetic changes. To be more scientific Pap tends to activation of tumour genes and deletions of part of chromosome 9 whereas CIS more often has loss of function of tumour suppressor genes.

What does it mean ?
For CIS, aside from resection to accurately stage the tumour and understand if it has started to invade the bladder wall, the treatment of choice I believe is treatment once a week for 6 weeks with BCG immunotherapy, The "cure" rate for CIS treated by BCG is quoted as being very high >80% success.
For Papillary tumours of medium to high grade, the recommendation is also resection, then a 6 week course of BCG.
The literature is somewhat split of the success of this regimen, with most big anayses concurring that BCG delays recurrence of new papillary tumours, but may not decrease the rate of progression(new invasive tumours). High grade "superficial" papillary tumours often present a conundrum for the treating physician as they are torn between treating in a conservative manner and sparing the patient discomfort or treating in an aggressive manner to prevent more serious disease.
After the course of BCG, you will have a a follow up cysto to look for residual tumour or new tumours. If you are clear at this stage, things are looking up, but you will need to have frequent checks on your bladder to monitor return of the tumours and may be advised to have follow up treatments with BCG.

I do not know how far down the rabbit hole you want to go on this as some folks find in comforting to know what might be in store and calculate odds, while others prefer to deal with each new development as afresh challenge.

Anyway, best of luck to all and thanks for being there

BCG 2/6

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10 years 5 months ago - 10 years 5 months ago #32726 by Patricia
sara anne..interestingly enough i had a single papillary tumor growing out of my CIS which the initial Uro did not see...he only saw the papillary tumor.....the pathologist found the CIS but apparently from what i've read this is not unusual.
P.S. one of the things reading this i did not realize
avoid misinterpreting inconsistent but sometimes prominent fascicles of muscularis mucosae (common in women) as belonging to muscularis propria
Why you really do need a second pathology report from a top cancer hospital especially if a female......amazing.

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10 years 5 months ago #32725 by sara.anne
Yes, Mike. I am doing well. What happened was that I was cleaning out a bunch of boxes in my study, looking for something specific (I FOUND IT!) and also found a bunch of other intersting stuff. This included my initial path report, reporting the papillary tumor, removed at TURB. Since the second TURB six weeks later found CIS, that is all I have been concerned with, and there is no sign that the papillary has returned. As I read the initial report, it occured to me that you guys might have some input as to what additional implications that might have had.

Have read that papillary is often more annoying than not, but that it does recurr often. Just my curiosity as to what I mght have missed.

Thanks to you and to Pat for the info.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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10 years 5 months ago - 10 years 5 months ago #32716 by Patricia
TCC is arbitrarily graded on a scale of I-III based on the degree of cytologic and architectural abnormalities.
many typical lesions (especially grade III and IV) show foci of squamous differentiation....
I don't know if the pathologists are all on the same page or not when it comes to grading or staging??
Here's a great paper on pathology if you can get through it!!


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10 years 5 months ago #32715 by mmc

What's grade IV on your definitions? Since Sara Anne was 2-3 on a 4 point scale it would seem like all 4 grades would be helpful.

Sara Anne, I don't know what it means in terms of progression/prognosis. I know the CIS is a much riskier beast. I would guess that a 2-3 on a 4 point scale means medium to medium high risk. CIS is always high risk.

The fact that it was removed and you've been doing BCG treatments and regular checking, my guess is you're doing the right things in terms of what would have the biggest affects on prognosis.

It's been a couple of years and you haven't mentioned it recurring so that's certainly a good sign.

I'd ask your uro about it to be sure. Sorry I can't be of more help.


Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results....distant mets
2/2014 ct result...spread to liver, kidneys, and lymph...

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10 years 5 months ago #32708 by Patricia
Forgive me...i can't do it in 10 words or less...and YES Virginia there is a Grade I
•The grade of the carcinoma is based primarily on the cytologic features of the epithelium
•Grade I carcinomas closely resemble normal urothelium; usually not more than seven cell layers thick; bland or minimally atypical nuclei and rare mitosis.
•Grade II carcinomas usually show thicker epithelium, i.e., more than 10 cell layers;a moderate degree of nuclear variability in size and chromasia.
•Grade III carcinomas show marked nuclear pleomorphism, readily recognizable mitotic figures; loss of nuclear polarity; and usually show loss of cohesiveness of the epithelial cells.
•Invasion into the lamina propria, muscularis, and lymphatic vessels are important prognostic features
pat :dry:

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