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Overview of Non-Muscle Invasive Bladder Cancer NMIBC

Medically reviewed by Faith Selchick, DNP, AOCNP, Nursing, Oncology — By David Rossiaky on October 19, 2022

What is non-muscle invasive bladder cancer NMIBC

Your bladder is a flexible, sac-like organ located in front of your pelvis. After your kidneys make urine, the liquid travels to your bladder, where it’s stored until it leaves your body. Your bladder is made of several layers. From the inside to the outside, the main layers are the:inner lining (urothelium, or transitional epithelium)connective tissuemuscle layerfatty layer It’s possible for your bladder to develop cancer. According to the American Cancer Society, more than 81,000 people in the United States will get bladder cancer in 2022, affecting men in about 75% of cases. About 90% of people with bladder cancer are older than 55. Bladder cancer usually starts in your bladder’s inner lining. When the cancer is only found in the inner lining or connective tissue layers, it’s called non-muscle invasive bladder cancer (NMIBC) because it hasn’t reached the muscle layer yet. Read on to learn more about NMIBC.

What causes non-muscle invasive bladder cancer

Any type of bladder cancer is the atypical growth of cells in your bladder. You have many types of cells in your bladder that can become cancerous, but the urothelial cells are by far the most frequent type to cause bladder cancer. Exactly what causes bladder cells to become cancerous isn’t known. However, certain things have been found to increase the risk of bladder cancers, including NMIBC. These include:tobacco use, especially smokinga family history of bladder cancergenetic mutationsexposure to certain industrial products, like paints, dyes, metals, and petroleum productsa history of radiation therapy around your pelvisprior use of some chemotherapy drugs, like cyclophosphamide or ifosfamidetaking the herb Aristolochia fangchidrinking water containing arsenic or chlorinea history of bladder infectionsprolonged use of urinary cathetersolder age

Non-muscle invasive bladder cancer symptoms

The most common symptom of bladder cancer is blood in your urine (hematuria). This does not necessarily mean your urine is dark red, though it can be in some cases. More often, you may notice your urine appears pink or orange. Other symptoms of NMIBC include:frequent or urgent urinationpainful urination (dysuria)difficulty urinatingback painpelvic pain Many of these symptoms overlap with less severe conditions, like urinary tract infections (UTIs), but even these can become serious if left untreated. If you’re experiencing these symptoms, visit a healthcare professional to determine the cause and begin treatment.

Grading and staging of non-muscle invasive bladder cancer

Bladder cancers are classified into grades and stages. This system helps doctors track the cancer’s progress and determine the best treatment methods.

Bladder cancer grades

Grades were previously expressed as a number (1 to 3). Today, they’re usually split into low grade (1 to around 2.5) or high grade (around 2.5 to 3). The less the cancer cells resemble healthy cells, the higher the grade. Higher grades are more likely to spread into your bladder’s muscle layer, and then beyond to other parts of your body.

Bladder cancer stages

Bladder cancer stages are expressed using the TNM system, which uses a number to describe each of three variables: tumor (T)lymph nodes (N)metastasis (M) The higher the T number, the deeper into your bladder’s layers the cancer has reached. NMIBC is any bladder cancer with a T number under 2. An N number greater than 0 means the cancer has reached at least one lymph node. An M number greater than 0 means the cancer has spread to a distant lymph node or another organ (most often the lungs, liver, or bones).

Potential complications

Complications of NMIBC can include:weight lossfatigueUTIurinary obstructionchronic kidney failure The risk of complications increases as the tumor grows. Because NMIBC tumors have not reached the bladder’s muscle layer, they’re generally smaller and less likely to cause complications when treated quickly than some other types of bladder cancer.

Diagnosing non-muscle invasive bladder cancer

NMIBC accounts for more than half of all bladder cancer diagnoses, reports the Bladder Cancer Advocacy Network. If a doctor suspects you may have any type of bladder cancer, including NMIBC, they will start by asking about your history and symptoms. They may also be able to feel a bladder tumor with a digital rectal exam or, if you have a vagina, a pelvic exam. Your doctor might refer you to a specialist called a urologist. They may take urine samples and blood samples, and send them to a lab for a number of tests that might detect cancer or other conditions with similar symptoms. Doctors may look inside your bladder with a small camera called a cystoscope, or by using imaging scans like MRI or a retrograde pyelogram. If any atypical areas are found, they may take a sample, called a biopsy.

Treatment of non-muscle invasive bladder cancer

There are several treatments for NMIBC. Not all treatments will be needed for every case of cancer. The cancer’s grade, stage, and response to treatment determine next steps.

Transurethral resection of bladder tumor TURBT

In TURBT surgery, a doctor passes a cystoscope through your urethra into your bladder and removes abnormal cells. They do not need to cut into the abdomen.

Intravesical chemotherapy

Intravesical chemotherapy is often done immediately after surgery. Chemotherapy drugs are introduced directly inside your bladder.

Intravesical immunotherapy

Immunotherapy helps your immune system fight cancer. Bacillus Calmette-Guerin (BCG), often used to vaccinate against tuberculosis, is put directly inside your bladder.

Cystectomy

During cystectomy, a surgeon removes your bladder. In some cases, it can be partially removed, but in other cases it must be removed entirely.

Next steps after diagnosis

After receiving an NMIBC diagnosis, you may be wondering what to do next. First, learn what you can about NMIBC and its treatment. Ask your doctor any questions you have, no matter how big or small. Expect to feel a variety of strong emotions. You may need time to process your diagnosis. Reach out to trusted loved ones, and consider joining a support group. If you’re able, and if your doctors approve, try to exercise and get outdoors. Doing things you enjoy is important for maintaining your mental health during treatment and beyond.

Non-muscle invasive bladder cancer survival rate

According to the American Cancer Society, the 5-year survival rate for NMIBC is 96%. This is higher than the survival rate for bladder cancer as a whole, which is 77%. It’s important to keep in mind that survival rates are broad estimates. They also generally do not account for the last 5 years’ worth of research. Your doctor can give you a more detailed outlook based on your unique circumstances.

Takeaway

Non-muscle invasive bladder cancer (NMIBC) is a type of bladder cancer that hasn’t spread beyond the inner layers of the bladder. Most people who receive a diagnosis of bladder cancer have NMIBC. The outlook for people with this stage of cancer is very good. The earlier cancer is detected, the better the outcome in most cases. If you suspect you may have NMIBC, make an appointment with a doctor. Last medically reviewed on October 19, 2022

How we vetted this article

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Babjuk M, et al. (2022). European Association of Urology guidelines on non–muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ).
sciencedirect.com/science/article/pii/S0302283821019783Bladder cancer. (2022).
cdc.gov/cancer/bladder/Bladder cancer. (n.d.).
cancer.org/cancer/bladder-cancer.htmlBladder cancer treatment (PDQ): Patient version. (2022).
ncbi.nlm.nih.gov/books/NBK66044/Bladder cancer types, stages and grades. (n.d.).
bcan.org/facing-bladder-cancer/bladder-cancer-types-stages-grades/Kaseb H, et al. (2022). Bladder cancer.
ncbi.nlm.nih.gov/books/NBK536923/Matuleqicz RS, et al. (2020). Non-muscle-invasive bladder cancer: Overview and contemporary treatment landscape of neoadjuvant chemoablative therapies.
ncbi.nlm.nih.gov/pmc/articles/PMC7393683/Non-muscle invasive bladder cancer. (2020).
urologyhealth.org/urology-a-z/n/non-muscle-invasive-bladder-cancerUnderstanding non muscle invasive bladder cancer (NMIBC). (2021).
bcan.org/understanding-non-muscle-invasive-bladder-cancer-nmibc/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 19, 2022 By David Rossiaky Edited By Roman Gokhman Medically Reviewed By Faith Selchick DNP, APRN, AOCNP Copy Edited By Sara Giusti Share this articleMedically reviewed by Faith Selchick, DNP, AOCNP, Nursing, Oncology — By David Rossiaky on October 19, 2022

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