If you’ve recently been diagnosed with bladder cancer, you may have heard your doctor use terms like papillary or sessile to describe your tumor. What do these terms mean, and how does your tumor type inform your diagnosis?

Let’s break down these terms:

What do “papillary” and “sessile” mean?

These adjectives describe the way the tumor grows inside the bladder—essentially, its shape and structure. They aren’t related to your specific bladder cancer type or stage.

• Papillary tumors grow into the hollow part of the bladder. Under a microscope or during a cystoscopy (a scope used to look inside the bladder), they often appear like tiny, soft fronds or finger-like projections. Some people describe them as looking a bit like seaweed or a small cauliflower. Because papillary tumors extend outward, they tend to stay more on the inner surface of the bladder wall at first.
  
• Sessile tumors, on the other hand, grow flat against the bladder wall. They spread more broadly and tend to grow deeper into the bladder tissue. Sessile tumors can sometimes be harder to remove completely and are more likely to be associated with more aggressive cancer types.

Why the shape matters

The growth pattern of a tumor gives doctors important clues about how it might behave:

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• Papillary tumors typically remain confined to the inner lining of the bladder (called the urothelium). Many papillary tumors are more likely to be non–muscle invasive when compared to sessile tumors. This means they haven’t grown into the deeper muscle layers of the bladder wall. This type of bladder cancer can often be treated successfully with procedures that remove the tumor from inside the bladder and may be followed by medications placed directly into the bladder (known as intravesical therapy).
  
• Sessile tumors can be more aggressive. Because sessile tumors grow flat and spread along the bladder wall, they’re more likely to invade the deeper layers of the bladder. When a tumor grows into or through the muscle layer, it’s called muscle-invasive bladder cancer. This type generally requires more intensive treatment—such as surgery to remove part or all of the bladder, chemotherapy, or sometimes radiation.
  

It’s important to remember that not all sessile tumors are muscle-invasive, and not all papillary tumors are confined to the lining of the bladder.

Doctors use the tumor’s shape along with other factors—such as grade, stage, and genetic markers—to fully understand your individual cancer.

Tumor grade and stage: telling more of the story

The words papillary and sessile only describe the shape. To understand your prognosis, your oncologist will also consider other details, such as:

1. Grade: This tells how abnormal the cancer cells look under a microscope.
   
   • Low-grade cancers grow slowly and are less likely to spread.
     
   • High-grade cancers grow faster and are more likely to invade deeper layers or recur after treatment.
     
     
2. Stage: This tells how far the cancer has spread.
   
   • Stage 0 and I cancers are non–muscle invasive.
     
   • Stages II and above involve the bladder muscle or areas beyond it.
     

Papillary tumors are often low-grade and early-stage, while sessile tumors are more likely to be high-grade or higher-stage; however, this is not always the case. Your care team will review your pathology report carefully to explain what applies to you and your specific experience.

What does this mean for your prognosis?

Your prognosis—or the health outcomes you can expect—depend on several factors: the tumor’s type (papillary vs. sessile), its grade and stage, your overall health, and how well your cancer responds to treatment.

• For papillary tumors: Many people have an excellent outlook. Even when these tumors return (which can happen), they’re often manageable with ongoing surveillance and treatment. Routine follow-ups with cystoscopy allow your care team to catch and treat any recurrences early.
  
• For sessile tumors: The outlook can vary depending on how deeply the cancer has invaded the bladder wall. Early detection and modern treatment approaches, including surgery, chemotherapy, immunotherapy, and clinical trials, continue to improve outcomes.
  

Remember: A “more aggressive” tumor doesn’t automatically mean a poor prognosis. Bladder cancer treatment has advanced significantly, and many people live long, healthy lives after diagnosis—especially when they work closely with their healthcare team and stick with regular follow-ups.

Always ask your doctor for additional explanation if you don’t understand your pathology report or after-visit summary. You can also connect with an oncology nurse practitioner directly using the Ask Outcomes4Me button in the Outcomes4Me app.