Bladder Cancer Staging

Bladder Cancer : Stages and Grades

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

Tumor (T):How large is the primary tumor? Where is it located?
Node (N):Has the tumor spread to the lymph nodes? If so, where and how many?
Metastasis (M):Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Staging can be clinical or pathological. Clinical staging is based on the results of tests done before surgery, which may include physical examinations, imaging scans, and biopsies. Pathological staging is based on what is found during surgery, including the results of physical examinations, imaging scans, and biopsies. In general, pathological staging gives the health care team the most amount of information to make a prognosis.

Here are more details on each part of the TNM system for bladder cancer.

T categories for bladder cancer:

T describes how far the main (primary) tumor has grown through the bladder wall and whether it has grown into nearby tissues.

These measurements refer to the primary tumor.

TX means the primary tumor cannot be assessed or information is not known.
TO means no evidence of primary tumor.
Ta indicates noninvasive papillary carcinoma.
Tis indicatesnoninvasive flat carcinoma, also called flat carcinoma in situ. This means that the disease is still localized, or contained within the urothelium layer of the bladder wall. Cancer cells have not invaded the deeper layers of bladder wall tissue.
T1 means the tumor has grown from the layer of cells lining the bladder into the connective tissue below. It has not grown into the muscle layer of the bladder.
T2 means the tumor has grown into the muscle layer. T2 has two sub-categories:
- T2a means the tumor is in the inner half of the muscle layer.
- T2b means the tumor is in the outer half of the muscle layer.
T3 means the tumor has grown through the muscle layer and into the surrounding fatty tissue. T3 has two sub-categories:
- T3a means this spread into the fatty tissue can only be seen with a microscope.
- T3b means this spread into the fatty tissue is large enough to be seen on imaging test or to be seen/felt by the surgeon.
T4 means the tumor has spread into nearby organs or structures. It may be growing in the stroma (main tissue) of the prostate, the seminal vesicles, uterus, vagina, pelvic wall or abdominal wall.

N categories for bladder cancer:

N indicates any cancer spread to lymph nodes near the bladder. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.

NX means nearby lymph nodes cannot be assessed or information is not known.
N0 means the cancer has not spread to any nearby lymph nodes.
N1 means the cancer has spread to one lymph node in the true pelvis.
N2 means the cancer has spread to two or more lymph nodes in the true pelvis.
N3 means the cancer has spread to lymph nodes that lie along the common iliac artery.

M categories for bladder cavity and oropharyngeal cancers:

M indicates if the cancer has spread (metastasized) to distant sites, such as other organs, like the lungs or liver, or lymph nodes that are not near the bladder.

M0: no distant spread
M1: the cancer has spread to distant sites outside the bladder region (for example, the lungs, liver or bones)

Once the categories have been assigned, the cancer is staged in one of the following ways:

Stage 0: The cancer has only grown into the center of your bladder. It hasn’t spread into the tissues or muscle of your bladder wall itself. It hasn’t spread to your lymph nodes or other organs, either.

Stage I: The cancer has grown through the inner lining of your bladder, but not the muscle of your bladder wall. Nor has it spread to your lymph nodes or distant organs.

Stage II: The cancer has grown through the connective tissue in your bladder and into the muscle layer of the bladder.

Stage III: Cancer is now in the layer of fatty tissue that surrounds your bladder. It may also be in your prostate, uterus, or vagina. But it hasn’t spread to nearby lymph nodes or to distant organs.

Stage IV (stage 4 bladder cancer): In stage IV bladder cancer, one of the following applies:

Cancer has grown through the bladder wall and into the pelvic or abdominal wall, but it has not spread to lymph nodes or distant sites.
Cancer has spread to nearby lymph nodes but not to distant sites.
Cancer has spread to distant sites, such as bones, liver or lungs.

10 common questions about Bladder Cancer Staging

1What are the stages of bladder cancer?

There are two types of stages for bladder cancer -- the clinical stage and the pathologic stage. The clinical stage is your doctor's informed opinion of how far your cancer has spread. This is based on results of a number of tests, including physical exams, imaging tests like MRIs or CT scans, and biopsies.

2Is Stage 3 bladder cancer curable?

If you have stage 3 bladder cancer, it means that cancer has spread into tissue outside your bladder. In women, it may have spread to their uterus or vagina. ... Though stage 3 bladder cancer is advanced, it can be successfully treated.

3Which lymph nodes does bladder cancer spread to?

This is called lymphatic spread. Bladder cancer can spread this way. If it does, it usually first spreads to the lymph nodes in the pelvis, surrounding the bladder (called perivesicular lymph nodes).

4Does bladder cancer spread quickly?

They tend to grow and spread slowly. High-grade bladder cancers look less like normal bladder cells. These cancers are more likely to grow and spread. They can be harder to treat.

5Is bladder cancer a death sentence?

Ninety percent (90%) of people with bladder cancer are older than 55, and the average age people are diagnosed with bladder cancer is 73. It is estimated that 17,670 deaths (12,870 men and 4,800 women) from this disease will occur this year. ... The general 5-year survival rate for people with bladder cancer is 77%

6How long can you live with stage 3 bladder cancer?

Stage 3. Around 30 out of 100 men (around 30%) and more than 15 out of 100 women (more than 15%) survive their cancer for 5 years or more after they are diagnosed. Stage 3 means that the cancer has grown through the muscle into the fat layer. It may have spread outside the bladder to the prostate, womb or vagina

7Is grade 3 bladder cancer a terminal?

Grade 1 – the cancer cells look a lot like normal bladder cells. They are usually slow-growing and are less likely to spread. Grade 2 – the cancer cells look more abnormal and grow slightly more quickly than grade 1 cancer. Grade 3 – the cancer cells look very abnormal.

8Is bladder cancer aggressive?

Cancer cells are grouped together and can often be easily removed. The cancer has not invaded the muscle or connective tissue of the bladder wall. ... This is always a high-grade cancer (see “Grades,” below) and is considered an aggressive disease because it can often lead to muscle-invasive disease.

9Can you survive stage 4 bladder cancer?

This means that with treatment you have a 15 percent chance of surviving for 5 years after a diagnosis of stage 4 bladder cancer. If the bladder cancer has spread to the regional lymph nodes, the 5-year survival rate is 34 percent. ... There are still treatment options for this stage.

10Where does bladder cancer usually metastasize to?

This is called local spread. This would be in places like your ureters, urethra, prostate, vagina or into the pelvis. Cancer that has spread to another part of the body is called a secondary cancer or metastasis. If bladder cancer does spread, it is most likely to spread to your lymph nodes, lungs, liver or bones.

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