The stage of a cancer tells the doctor how far it has spread.  It is important because treatment is often decided according to the stage of a cancer.  There are different ways of staging cancers.  The most common amongst doctors is the TNM system.  This is common to all cancers.  TNM stands for ‘tumour, node, metastasis’.  So this staging system takes into account how deep the tumour has grown into the bladder, whether there is cancer in the lymph nodes and whether the cancer has spread to any other part of the body.  Doctors call cancer spread ‘metastasis’.  The TNM system is a quick and detailed way of writing down the stage of a cancer accurately.  There is more about the TNM cancer stages in our About Cancer section.

Another way of staging cancers is number staging.  This is used for other cancers, but not so much for bladder cancer.  There are usually 4 main stages.  Stage 1 is the earliest cancer and stage 4 the most advanced.  With bladder cancer, it is more usual to refer to early (or superficial) bladder cancer, invasive bladder cancer and advanced bladder cancer.

What is ‘grade’?

You may hear your doctor talk about the ‘grade’ of your cancer. This means how well developed the cell looks like under the microscope.  The more the cancer cell looks like a normal cell, the more it will behave like one

—      The more normal a cancer cell looks, the lower its grade    

—      The more abnormal or less well developed a cancer cell is, the higher its grade

Cancer cells are usually classed as low, medium or high grade.  Other doctors may talk about grades 1, 2, or 3, where G1 is low grade.  A low grade cancer is likely to be less aggressive in its behaviour than a high grade one. Doctors cannot be certain how the cells will behave. But grade is a useful indicator.

If you have early bladder cancer, grade is one thing that your doctor may take into account when deciding your treatment.  If the cells are high grade, you are more likely to need further treatment to stop the cancer coming back after your specialist has removed it.  Carcinoma in situ of the bladder is high grade.

The ‘T’ stages of bladder cancer

The ‘T’ of TNM tells you how far into the bladder the cancer cells have grown

—      CIS - very early cancer cells are detected only in the innermost layer of the bladder lining     

—      Ta - the cancer is just in the innermost layer of the bladder lining     

—      T1 - the cancer has started to grow into the connective tissue beneath the bladder lining     

—      T2- the cancer has grown through the connective tissue into the muscle   

—      T2a - the cancer has grown into the superficial muscle    

—      T2b - the cancer has grown into the deeper muscle     

—      T3 - the cancer has grown through the muscle into the fat layer   

—      T3a - the cancer in the fat layer can only be seen under a microscope (microscopic invasion)    

—      T3b - the cancer in the fat layer can be seen on tests, or felt by the doctor (macroscopic invasion)   

—      T4 - the cancer has spread outside the bladder   

—      T4a - the cancer has spread to the prostate, womb or vagina   

—      T4b - the cancer has spread to the wall of the pelvis and abdomen

The ‘N’ stages of bladder cancer

There are four lymph node stages in bladder cancer.  These relate to lymph nodes in the pelvis (the lower part of your tummy, inside your hip bones, or pelvic girdle).  The stages are

—      N0 - no cancer in any lymph nodes     

—      N1 - one affected lymph node smaller than 2cm across     

—      N2 - one affected lymph node larger than 2cm, but smaller than 5cm. Or more than one node affected, but all of them smaller than 5cm across     

—      N3 - at least one affected lymph node larger than 5cm across

The size of the lymph nodes is used because the more cancer there is growing in a lymph node, the larger it will be.

If you have cancer in lymph nodes, then you have invasive bladder cancer that has begun to spread.  It is also possible for bladder cancer to spread to lymph nodes in the abdomen (above the pelvic area) or to lymph nodes in the neck.

If you have cancer in any lymph nodes, your doctor may want you to have chemotherapy treatment before surgery.  Look at the CancerHelp UK sections on treating invasive bladder cancer and treating advanced bladder cancer for more information.

The ‘M’ stages of bladder cancer

As with most cancers, there are two stages for cancer spread or metastases.  Either the cancer has spread to another body organ (M1) or it hasn’t (M0).  If bladder cancer does spread to another part of the body, it is most likely to go to the bones, lungs or liver.  If your cancer has spread, then you have advanced bladder cancer.  Look at the CancerHelp UK section on treating advanced bladder cancer for more information.

Early bladder cancer and carcinoma in situ

Early bladder cancer is also called ’superficial bladder cancer’.  This includes Ta tumours, T1 tumours and carcinoma in situ (CIS). CIS is called Tis in the bladder cancer TNM staging.

All these are cancers that have been picked up early in their development.  The cancer cells are only in the innermost layer of the bladder - in the lining.  Often, these early bladder tumours look like mushrooms growing out of the bladder wall.  In many cases, these cause no more trouble after your specialist has removed them.

Carcinoma in situ doesn’t stick out from the bladder wall.  It is a cancer of the flat transitional cells that make up all the moist skin-like tissues that line the body organs.  CIS can crop up in more than one place in the bladder lining.

There is a group of early bladder cancers that doctors call ‘high risk’.  They are more likely to come back.  And more likely to go on to develop into a more dangerous invasive bladder cancer.  This group includes carcinoma in situ and T1 tumours.  T1 tumours have started to grow further into the bladder wall than the lining.  The cancer cells have broken through the base of the lining into the supporting tissue underneath.  CIS is ‘high risk’ because the cells are very abnormal.  Doctors call this ‘high grade’.  High grade cancer cells are more likely to grow quickly into the bladder muscle and spread than low grade ones.

If you have ‘high risk’ early bladder cancer, your specialist will want you to have more treatment after removing the cancer.  This will be treatment to the inside of your bladder called intravesical therapy.  This is included in the section on treating early bladder cancer in CancerHelp UK.

Invasive bladder cancer

If you have stage T2 or T3 bladder cancer, then this is called invasive bladder cancer.  In T2, the cancer has grown into (or invaded) the muscle layer of the bladder.  In T3, the cancer has grown through the muscle layer.  There is more risk that the cancer could spread than with early bladder cancer.  There is a section on treating invasive bladder cancer in CancerHelp UK.

Advanced bladder cancer

Advanced bladder cancer includes T4 bladder cancer, cancer in the lymph nodes or cancer that has spread to another part of the body.  But if the cancer spread is only local (in the area around the bladder, or to local lymph nodes), your specialist may treat you as if you had T2 or T3 invasive bladder cancer.

Advanced bladder cancer can be cancer that has come back (recurrence).  There is a section on treating advanced bladder cancer with more information.

CancerHelp UK is not designed to provide medical advice or professional services and is intended to be for educational use only. The information provided through CancerHelp UK is not a substitute for professional care and should not be used for diagnosing or treating a health problem or a disease. If you have, or suspect you may have, a health problem you should consult your doctor.

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