What staging is?
Staging is a way of describing where the cancer is located, if or where it has invaded or spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
For bladder cancer, the stage is determined based on the results of the sample removed during a TURBT and whether the cancer has spread to other parts of the body, which is determined by imaging tests, a physical examination, and laboratory tests.
One tool doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages of bladder cancer: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
The T part of TNM tells you how far into the bladder the cancer cells have grown. Doctors find the T stage by a combination of looking at the grade of the cancer cells after a biopsy, examination of the bladder under anaesthetic, and a CT scan or MRI scan.
TX: Main tumor cannot be assessed due to lack of information
T0: No evidence of a primary tumor
Ta: Non-invasive papillary carcinoma
Tis: Non-invasive flat carcinoma (flat carcinoma in situ, or CIS)
T1: 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: The tumor has grown into the muscle layer.
The N stages of bladder cancer
The N category describes spread only to the lymph nodes near the bladder (in the true pelvis) and those along the blood vessel called the common iliac artery. These lymph nodes are called regional lymph nodes. Any other lymph nodes are considered distant lymph nodes. Spread to distant nodes is considered metastasis (described in the M category). Surgery is usually needed to find cancer spread to lymph nodes, since it is not often seen on imaging tests.
NX: Regional lymph nodes cannot be assessed due to lack of information.
N0: No cancer in any lymph nodes
N1: There is cancer in one lymph node in the pelvis (the lower part of your tummy, between your hip bones)
N2: There is cancer in more than one lymph node in the pelvis
N3: There is cancer in one or more lymph nodes in the groin
The M stages of bladder cancer
M0: There are no signs of distant spread.
M1: The cancer has spread to distant parts of the body. (The most common sites are distant lymph nodes, the bones, the lungs, and the liver).
Staging is a way of describing where the cancer is located, if or where it has invaded or spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
For bladder cancer, the stage is determined based on the results of the sample removed during a TURBT and whether the cancer has spread to other parts of the body, which is determined by imaging tests, a physical examination, and laboratory tests.
One tool doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages of bladder cancer: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
- How large is the primary tumor and how deeply has it invaded the tissue? (Tumor, T)
- Has the tumor spread to the lymph nodes? (Node, N)
- Has the cancer metastasized to other parts of the body? (Metastasis, M)
The T part of TNM tells you how far into the bladder the cancer cells have grown. Doctors find the T stage by a combination of looking at the grade of the cancer cells after a biopsy, examination of the bladder under anaesthetic, and a CT scan or MRI scan.
TX: Main tumor cannot be assessed due to lack of information
T0: No evidence of a primary tumor
Ta: Non-invasive papillary carcinoma
Tis: Non-invasive flat carcinoma (flat carcinoma in situ, or CIS)
T1: 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: The tumor has grown into the muscle layer.
- T2a: The tumor has grown only into the inner half of the muscle layer.
- T2b: The tumor has grown into the outer half of the muscle layer.
- T3a: The spread to fatty tissue can only be seen by using a microscope.
- T3b: The spread to fatty tissue is large enough to be seen on imaging tests or to be seen or felt by the surgeon.
- T4a: The tumor has spread to the stroma of the prostate (in men), or to the uterus and/or vagina (in women).
- T4b: The tumor has spread to the pelvic wall or the abdominal wall.
The N stages of bladder cancer
The N category describes spread only to the lymph nodes near the bladder (in the true pelvis) and those along the blood vessel called the common iliac artery. These lymph nodes are called regional lymph nodes. Any other lymph nodes are considered distant lymph nodes. Spread to distant nodes is considered metastasis (described in the M category). Surgery is usually needed to find cancer spread to lymph nodes, since it is not often seen on imaging tests.
NX: Regional lymph nodes cannot be assessed due to lack of information.
N0: No cancer in any lymph nodes
N1: There is cancer in one lymph node in the pelvis (the lower part of your tummy, between your hip bones)
N2: There is cancer in more than one lymph node in the pelvis
N3: There is cancer in one or more lymph nodes in the groin
The M stages of bladder cancer
M0: There are no signs of distant spread.
M1: The cancer has spread to distant parts of the body. (The most common sites are distant lymph nodes, the bones, the lungs, and the liver).
Bladder Cancer Stage Grouping
Once the T, N, and M categories have been determined, this information is combined to find the overall cancer stage. Bladder cancer stages are defined using 0 and the Roman numerals I to IV (1 to 4). Stage 0 is the earliest stage, while stage IV is the most advanced.
Stage 0a (Ta, N0, M0)
This is an early cancer that is only found on the surface of the inner lining of the bladder. 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 type of bladder cancer is also called noninvasive papillary urothelial carcinoma (Ta, N0, M0).
Stage 0is (Tis, N0, M0)
The cancer is a flat, non-invasive carcinoma (Tis), also known as flat carcinoma in situ (CIS). The cancer is growing in the inner lining layer of the bladder only. It has neither grown inward toward the hollow part of the bladder nor has it invaded the connective tissue or muscle of the bladder wall. It has not spread to lymph nodes (N0) or distant sites (M0).
Stage I (T1, N0, M0)
The cancer has grown through the inner lining of the bladder to the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).
Stage II (T2a or T2b, N0, M0)
The cancer has grown into the thick muscle layer of the bladder wall, but it has not passed completely through the muscle to reach the layer of fatty tissue that surrounds the bladder (T2). The cancer has not spread to lymph nodes (N0) or to distant sites (M0).
Stage III (T3a, T3b, or T4a, N0, M0)
The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder. It may also have spread to the prostate in a man or the uterus and vagina in a woman. It has not spread to the lymph nodes or other organs (T3a, T3b, or T4a, N0, M0).
Stage IV
One of the following applies:
What grade is?
Your doctor may talk to you about the grade of your cancer. This means how well developed the cells look under the microscope.
In 2004 the World Health Organisation developed a new grading system for early bladder cancer, which is increasingly being used. This system divides bladder cancers into the following groups
Once the T, N, and M categories have been determined, this information is combined to find the overall cancer stage. Bladder cancer stages are defined using 0 and the Roman numerals I to IV (1 to 4). Stage 0 is the earliest stage, while stage IV is the most advanced.
Stage 0a (Ta, N0, M0)
This is an early cancer that is only found on the surface of the inner lining of the bladder. 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 type of bladder cancer is also called noninvasive papillary urothelial carcinoma (Ta, N0, M0).
Stage 0is (Tis, N0, M0)
The cancer is a flat, non-invasive carcinoma (Tis), also known as flat carcinoma in situ (CIS). The cancer is growing in the inner lining layer of the bladder only. It has neither grown inward toward the hollow part of the bladder nor has it invaded the connective tissue or muscle of the bladder wall. It has not spread to lymph nodes (N0) or distant sites (M0).
Stage I (T1, N0, M0)
The cancer has grown through the inner lining of the bladder to the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).
Stage II (T2a or T2b, N0, M0)
The cancer has grown into the thick muscle layer of the bladder wall, but it has not passed completely through the muscle to reach the layer of fatty tissue that surrounds the bladder (T2). The cancer has not spread to lymph nodes (N0) or to distant sites (M0).
Stage III (T3a, T3b, or T4a, N0, M0)
The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder. It may also have spread to the prostate in a man or the uterus and vagina in a woman. It has not spread to the lymph nodes or other organs (T3a, T3b, or T4a, N0, M0).
Stage IV
One of the following applies:
- T4b, N0, M0: The cancer has grown through the bladder wall and into the pelvic or abdominal wall (T4b). The cancer has not spread to lymph nodes (N0) or to distant sites (M0). Or,
- Any T, N1 to N3, M0: The cancer has spread to nearby lymph nodes (N1-N3) but not to distant sites (M0). Or,
- Any T, any N, M1: The cancer has spread to distant lymph nodes or to sites such as the bones, liver, or lungs (M1).
What grade is?
Your doctor may talk to you about the grade of your cancer. This means how well developed the cells look under the microscope.
- Low grade cancers have cells that look very like normal cells – they are called low grade or well differentiated and tend to grow slowly and to stay in the lining of the bladder
- Medium grade cancers have cells that look more abnormal – they are called moderately differentiated and are more likely to spread into the muscle of the bladder (progress) or to come back after treatment
- High grade cancers have cells that look very abnormal – they are called high grade or poorly differentiated, are quickly growing, more likely to come back after treatment and more likely to spread into the bladder muscle (progress)
In 2004 the World Health Organisation developed a new grading system for early bladder cancer, which is increasingly being used. This system divides bladder cancers into the following groups
- Urothelial papilloma – non cancerous (benign) tumour
- Papillary urothelial neoplasm of low malignant potential (PUNLMP) – very slow growing and unlikely to spread
- Low grade papillary urothelial carcinoma – slow growing and unlikely to spread
- High grade papillary urothelial carcinoma – more quickly growing and more likely to spread