Bladder Cancer

Staging bladder cancer

Once bladder cancer is diagnosed, your doctor needs to establish if the disease has spread and if so, to what other parts of the body. Diagnostic testing helps determine how invasive the cancer is based on how far the disease has spread in and around the bladder. Bladder cancer is classified as one of the following:

  • Noninvasive – confined to the inner layers of the bladder; noninvasive bladder cancer is also called superficial or non-muscle invasive.
  • Invasive – the cancer has grown deep into the bladder or spread to lymph nodes or other organs.

In addition to knowing whether the cancer is noninvasive or invasive, knowing the stage and grade of bladder cancer will help you and your health care team choose the most effective treatment plan possible.

 

Stage of disease

Bladder cancer is usually staged in two phases:

  1. Clinical stage – based on the results of a physical examination, evaluation of biopsy specimens, and the results of imaging studies and CT scans.
  2. Pathologic stage – based on more invasive testing, including surgery, in order to accurately establish how far the disease has spread. Assigning this stage normally includes the removal and testing of the bladder and/or nearby lymph nodes to examine the tissue. This stage is assigned by a pathologist, a specialist in determining the cause of diseases, including cancer.

TNM system

One of the most standard ways to classify a cancer stage is through the TNM system, which was developed by the American Joint Committee on Cancer (AJCC). Doctors take into consideration the size and location of the tumor itself (T), whether cancer cells are found in nearby lymph nodes (N) and if the cancer has metastasized, or spread, to other parts of the body (M) (see Table 1).

Once the bladder cancer has been classified according to the TNM system, an overall stage will be assigned (see Table 2).

  • Stage 0 – Abnormal cells that may lead to cancer are present in only the innermost layer of the bladder lining. This stage has two subcategories: Stage 0a refers to noninvasive papillary carcinomas, and Stage 0is refers to flat carcinoma in situ. This is the earliest and most treatable stage of cancer.
  • Stage I – Cancer cells are confined to the bladder, but the tumor has grown through the inner layer of the bladder lining and into the connective tissue of the bladder. Stage I cancer is typically very treatable.
  • Stage II – Cancer cells are confined to the bladder, but the tumor has grown through the first two layers of the bladder lining and into the muscle layer.
  • Stage III – Cancer cells have spread to the outermost layer of the bladder (serosa) and may also have spread to the prostate (in men) or the uterus and/or vagina (in women). The cancer has not yet spread to the lymph nodes or other organs.
  • Stage IV – Cancer cells have spread in one of three ways. They may have spread to the pelvic or abdominal walls but not to lymph nodes or other parts of the body. They may have spread to one or more regional lymph nodes but not to other parts of the body. Or they may have spread to other parts of the body, with or without affecting lymph nodes.

Tumor grade

The pathologist will also assign a grade to bladder cancer depending on how the cancer cells look under a microscope. The grades are as follows:

  • Low-grade – also known as well-differentiated, is assigned when the cancer cells look similar to normal bladder tissue cells.
  • High-grade – also known as poorly differentiated or undifferentiated is assigned when the cancer cells look more abnormal; high-grade cancer is known to be more aggressive.

Table 1. AJCC system for bladder cancer

Category Definition
Tumor (T)
TX Primary tumor cannot be assessed 
T0 There is no evidence of primary tumor
Ta A papillary carcinoma is detected but is considered to be noninvasive
Tis There is evidence of a noninvasive flat carcinoma (flat carcinoma in situ, or CIS)
T1
 
The tumor has grown from the inner lining of the bladder to the connective tissue, but hasn't yet spread to the muscle layer of the bladder
T2
  T2a
  T2b
The tumor has invaded the muscle layer of the bladder
The tumor has grown into only the inner half of the muscle layer
The tumor has grown into the outer half of the muscle layer
T3

  T3a
  T3b
The tumor has grown through the muscle into the fatty tissue (also known as the perivesicle fat or serosa)
Invasion of the tumor to the serosa can be seen only through a microscope
Invasion of the tumor to the serosa can be felt by the surgeon or seen on imaging tests
T4
 
  T4a
  T4b
The tumor has spread beyond the bladder and may be growing into surrounding organs, seminal vesicles and the pelvic and abdominal wall
The tumor has spread to the prostate in me or to the uterus and/or vagina in women
The tumor has spread to the pelvic wall or abdominal wall
Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 Cancer has not spread to regional lymph nodes
N1 Cancer has spread to one pelvic lymph node
N2 Cancer has spread to two or more pelvic lymph nodes
N3 Cancer has spread to lymph nodes along the common iliac artery
Metastasis (M)
M0 Cancer has not spread to distant areas of the body
M1
Cancer has spread to distant areas of the body (most commonly to distant lymph nodes, bones, the lungs and/or the liver)

 

Table 2. Stages of bladder cancer

Stage TNM Classifications
0a Ta N0 M0
0is Tis N0 M0
 
I T1 N0 M0
II T2a or T2b N0 M0
III T3a, T3b or T4a N0 M0
IV Tb4
Any T
Any T
N0
N1, N2 or N3
Any N
M0
M0
M1

Staging Illustrations

Additional Resources

 

Previous Next

 



Register Now! Sign Up For Our Free E-Newletter!

Read Inspiring Cancer Survivor Stories

Order Your Guides Here