Non-papillary tumors are usually high grade and invade extensively and deeply into the bladder wall. The pathologic stage of transitional cell carcinoma is a better prognostic indicator than the histologic grade. Jewett A - tumor confined to the mucosa and submucosa. Jewett D - lymph node metastases. The natural history of transitional cell carcinoma is one of multiple recurrences over long periods of time, with a tendency for subsequent tumors to show greater anaplasia and to invade deeper.
Recurrence rates increase with grade.
Patients present with urinary frequency, dysuria or urgency. Microscopic hematuria is very common but gross hematuria is present in an occasional patient. The lesions are typically multifocal and are particularly common in patients with multiple or recurrent tumors in the bladder or elsewhere in the urinary tract. Foci are most frequent near tumors, but can occur in distant parts of the bladder. The gross appearances range from normal looking to granular, erythematous areas with no intraluminal projections.