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Staging of Bladder Cancer

Once cancer has been diagnosed, the next step is to choose the best way to treat it. To help do this, your healthcare provider uses tests and scans to find out how deep the cancer has grown and if it has spread. (This is called the cancer stage.)

Stage: How much the cancer has grown and spread

As cancer cells multiply, the tumor grows. Bladder cancer starts in the inner lining of the bladder. It often doesn’t grow beyond that layer. But as the tumor gets bigger, it may grow into deeper layers of the bladder. It may also spread to nearby organs, such as the prostate in men or the uterus in women. Cells can break off from the main tumor and go into the bloodstream or lymph nodes. Blood or lymph then carries the bladder cancer cells to other parts of the body, such as the bones, liver, or lungs, where a new tumor may form. (This is called metastasis. When in happens, it's called metastatic bladder cancer.)

Cross section of bladder wall showing cancer at superficial stage.
At the superficial stage (noninvasive), the tumor is only in the bladder lining and submucosal layer of the bladder.
Cross section of bladder wall showing cancer at invasive stage.
At the invasive stage, the tumor has begun to grow into the muscle or fat layers of the wall of the bladder.
Cross section of bladder wall showing cancer at metastatic stage.
At the metastatic stage, cancer cells from the main tumor have spread beyond the bladder to other parts of the body.

The stage of cancer is based on where the cancer is and how much it has grown and spread. The stage is found by looking inside the bladder during cystoscopy and doing imaging tests that show the bladder, the areas around it, and parts of the body that the cancer may have spread to.

The staging system described here is a simplified one. Your healthcare provider will most likely use a staging system that's much the same, but more detailed.

The TNM system used for bladder cancer

The most commonly used system to stage bladder cancer is the TNM system from the American Joint Committee on Cancer. Staging is very important for deciding what treatment to use. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The first step in staging your cancer is to decide the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

  • T tells how far the main tumor has spread into the lining of your bladder wall and if it has grown into nearby tissues.

  • N tells if the lymph nodes near the bladder have cancer cells in them.

  • M tells if the cancer has spread to other distant organs in the body, such as the liver, lung, or bones.

Number values are assigned to the T, N, and M categories. There are also 2 other values that can be assigned:

  • X means the provider doesn't have enough information to assess the extent of the main tumor ( TX), or if the lymph nodes have cancer cells in them ( NX). This value is often assigned before surgery.

  • T0 means the main tumor hasn't been found. N0 means there's no sign of cancer in the nearby lymph nodes.

Stages of bladder cancer

These are the stage groupings of bladder cancer and what they mean:

Stage 0. Cancer is only in the inner lining of the bladder. It has not spread at all. It's 1 of these:

  • Stage 0a. Noninvasive papillary carcinoma. These tumors are growing toward the inside of the bladder on a stalk (like a mushroom).

  • Stage 0is. Flat, noninvasive carcinoma or flat carcinoma in situ. These tumors are growing flat along the inner lining of the bladder, but not deeper into the bladder wall.

Stage I. The cancer has grown into the layer of tissue under the lining of the bladder. It has not reached the deeper muscle layers. It has not spread anywhere else.

Stage II. Cancer has spread into the deeper muscle layers, but not through them to the fatty tissue that's around the bladder. It has not spread anywhere else.

Stage III. The cancer has not grown into the pelvic or abdominal wall. It might have grown into the prostate, seminal vesicles, uterus, or vagina. But it has not spread to parts of your body far away from your bladder. It also falls into 1 of these 2 subgroups:

  • Stage IIIA. The cancer has grown into the layer of fat around the bladder or it's in 1 pelvic lymph node that's not near main blood vessels.

  • Stage IIIB. The cancer has grown into any of the layers of the bladder. It's also in 2 or more pelvic lymph nodes or it's in lymph nodes along the main blood vessels in the pelvis.

Stage IV. This stage is divided into 2 groups:

  • Stage IVA. The cancer has grown from the lining through the bladder wall and into the wall of the pelvis or abdomen. It might be in nearby lymph nodes. But it has not spread to parts of your body far away from your bladder.

  • Stage IVB. Cancer might have grown through the bladder wall and into nearby organs. It might also be in nearby lymph nodes. The cancer has spread to lymph nodes or organs far from your bladder, like your bones, liver, or lungs.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Louise Cunningham RN BSN
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 9/1/2021
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