People with bladder cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person 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 and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for bladder cancer.
Superficial bladder cancer (Ta, Tis, T1)
Overall, superficial bladder cancer has a good prognosis.
Stage
The stage of superficial bladder cancer is an important prognostic factor.
- Stage 0a has the most favourable prognosis – recurrent cancers that may develop in the urinary system are rarely deeply invasive.
- Stage 0is has a prognosis that is not quite as favourable as stage 0a – there is a greater risk of carcinoma in situ eventually developing into a cancer that invades the muscle.
- Stage I has a prognosis that is not quite as favourable as stage 0a – especially tumours that are grade 3.
Grade
The lower the grade, the more favourable the prognosis. Grade 3 tumours have a greater risk of disease progression and a less favourable prognosis. The risk of progression based on tumour grade is:
- grade I – 10% to15%
- grade 2 – 14% to 37%
- grade 3 – 33% to 64%
Number of tumours
People with a single, small tumour have the lowest risk for recurrence and have a more favourable prognosis.
Tumour size
Smaller tumour size is a more favourable prognostic factor than large tumour size.
Prior recurrence rate
About 40–60% of superficial bladder tumours recur. Treatment with adjuvant intravesical biological therapy helps reduce recurrence.
Carcinoma in situ that recurs in spite of adjuvant therapy is associated with about a 63% risk of progression to invasive bladder cancer, which is a less favourable prognostic factor. Likewise, an early recurrence is a less favourable prognostic factor.
Locally advanced and metastatic bladder cancer (T2–T4, M0–M1)
Stage
The stage of bladder cancer is an important prognostic factor. The earlier the stage, the more favourable the prognosis. The deeper the cancer has spread into the bladder wall or surrounding tissue, the less favourable the prognosis. Cancer that has spread to the lymph nodes or to other areas of the body has a poorer prognosis.
Grade
Aggressive, fast-growing tumours have a poorer prognosis than slower growing tumours. The lower the grade, the more favourable the prognosis.
Cell type
Some types of bladder cancer grow quickly and have a less favourable prognosis than others.
Concomitant carcinoma in situ
Carcinoma in situ (Tis) occurring at the same time as locally advanced cancer is a less favourable prognostic factor.
Tumour size
Smaller tumours have a more favourable prognosis than larger tumours.
Response to chemotherapy
Tumours that respond to chemotherapy that is given before surgery (to shrink the tumour) or to chemotherapy that is given to treat metastatic cancer have a more favourable prognosis.
Age
Younger age is a more favourable prognostic factor. Older age may be associated with decreased performance status and other health problems that could result in less tolerance for treatment.
Performance status
People with a high performance status (Karnofsky score 70 or greater) have a more favourable prognosis than those with a lower performance status.