How Is Bladder Cancer Staged?

“The grade tells you how aggressive this cancer looks under the microscope. The stage tells you how far the cancer has spread, either within the bladder, through the bladder layers or to other parts outside the body.”

Doctors may stage bladder cancer based on clinical staging, which involves a physical exam, imaging tests and sometimes a biopsy. The bladder cancer stage may also be given as a pathologic staging after surgery to remove bladder cancer tumors.

• Clinical staging helps determine the bladder cancer stage by evaluating how large the tumor is and whether it has spread to nearby tissues.
• Pathologic staging is done on bladder tumors that have been surgically removed during a transurethral resection of bladder tumor (TURBT). A pathologist examines the bladder tissue for bladder cancer cells and stage. This method of staging is more accurate than clinical staging, but may not always be done.

Staging With the TNM System

There are several ways cancer can be staged. Of these, the TNM classification system is most common. This method for staging bladder cancer is based on three factors:

• T = Tumor size: How large is the bladder tumor? What does it look like under a microscope?
• N = Lymph nodes affected by bladder cancer spread: Have cancer cells reached nearby lymph nodes?
• M = Metastases: Have cancer cells spread to other distant parts of the body?

T Category: Primary Tumor

The T category describes the site where cancer began in the bladder.

• TX: Primary tumor can’t be measured
• T0: Primary tumor can’t be found
• Tis: Contained in the inner lining of the bladder
• T1: Grown into the connective tissue, but hasn’t spread into the muscle
• T2: Grown into the muscle layer of the bladder
• T3: Grown into the fatty tissue surrounding the bladder
• T4: Spread through all bladder layers

N Category: Lymph Node Involvement

Cancer can spread from the primary tumor to nearby lymph nodes. The N category describes bladder cancer spread to regional lymph nodes within the pelvis.

• NX: Lymph node involvement can’t be measured
• N0: No bladder cancer spread to nearby lymph nodes
• N1: Spread from the primary bladder tumor to only one regional lymph node
• N2: Spread from the primary bladder tumor to 2 or more regional lymph nodes
• N3: Spread from the bladder to lymph nodes located along the common iliac artery, which provides blood supply to the lower limbs

M Category: Metastasis (spread)

The M category describes bladder cancer that has spread to other parts of the body.

• M0: Has not spread to the lymph nodes or to distant areas of the body
• M1a: Has spread to distant lymph nodes
• M1b: Has spread to distant organs

Overall Bladder Cancer Stages

Once your bladder cancer stage is determined based on the TNM system, your doctor will identify the overall stage of your cancer.

• Stage 0a: Cancer is located inside the bladder, but has not yet grown into the bladder wall tissue
• Stage 0is: Cancer is located on the lining of the bladder, but has not yet spread into the bladder’s muscle or connective tissue
• Stage 1: Has grown into the bladder’s connective tissue, but has not yet spread into the layer of muscle
• Stage 2: Has grown into the bladder’s muscle layer, but has not yet spread into the fatty tissue
• Stage 3A: Has spread into the fatty tissue of the bladder and possibly into some of the reproductive organs, or into the pelvic lymph nodes
• Stage 3B: Has spread to at least one regional lymph node or to multiple pelvic lymph nodes
• Stage 4A: Has spread beyond the bladder into the pelvic or abdominal wall, or to lymph nodes outside the pelvic region
• Stage 4B: Has spread beyond the bladder to one or more distant organ

Bladder Cancer Grade

Your doctor may also grade your cancer based on how the cells look under a microscope. Grading helps determine how aggressive bladder cancer is and what bladder cancer treatment may be most effective.

• Low-grade: Less likely to spread than bladder cancer described as high-grade
• High-grade: More likely to spread than bladder cancer described as low-grade

“The type of treatment you get for your bladder cancer depends on the stage and grade of your cancer,” adds Dr. Shah. Using these classification systems can help you understand your bladder cancer diagnosis, and arm yourself with the knowledge to make the best bladder cancer treatment decisions.

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