Tumor Grade, Risk Stratification, and Patient Counseling

This segment explains how pathology from a transurethral resection of bladder tumor (TURBT) determines grade, stage, and risk category. The faculty describe low-grade tumors as cancerous but more normal appearing and slower dividing, while high-grade tumors are more aggressive. For high-grade tumors, pathologists assess whether the cancer has invaded the lamina propria, which remains non-muscle invasive, or the detrusor muscle, which is muscle invasive and potentially life-threatening. The panel notes that most patients living with bladder cancer have non-muscle invasive disease, and many of them have low-grade pathology. Low-grade intermediate-risk disease includes large tumors at initial diagnosis, multifocal tumors, and early recurrence. High-risk disease includes high-grade invasive tumors, carcinoma in situ, and large high-grade papillary tumors. On counseling, one panelist encourages patients to bring family members, take notes, and lean on support systems. The other frames low-grade disease as a chronic, recurrent condition with a low risk of progression when treatment and follow-up are appropriate.