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
Max
TaG3
TURB
BCG 2/6