Staging helps the healthcare team estimate how serious the cancer is and choose treatments that are most likely to help. Bladder cancer is staged from 0 to 4. Bladder cancer stages describe how far the cancer has grown and whether it has spread. A lower number generally means the cancer is limited to the bladder. A higher number means it has grown farther through the bladder wall or spread beyond the bladder.
Staging terms
Bladder cancer staging looks at three things: the tumor, nearby lymph nodes and whether the cancer has spread to other parts of the body. These are described with the letters T, N and M. T describes how deeply the tumor has grown into or through the bladder wall. N describes whether cancer has spread to nearby lymph nodes. M describes whether cancer has spread to other parts of the body. These findings are combined to give an overall stage from 0 to 4.
Another important distinction is whether the cancer is non-muscle-invasive or muscle-invasive. Non-muscle-invasive bladder cancer has not grown into the bladder muscle. Muscle-invasive bladder cancer has grown into the muscle layer and has a greater risk of spreading.
Staging tests
The healthcare team determines the stage using information from TURBT and biopsy results along with imaging tests. CT or MRI scans of the abdomen and pelvis can help show whether cancer has grown outside the bladder or spread to lymph nodes. Chest imaging can show cancer that has spread to the lungs. Bone imaging may be used when symptoms or other findings suggest that cancer could have spread to bone.
Stage 0
Stage 0 bladder cancer is limited to the innermost lining of the bladder. It has not grown into the tissue beneath the lining or the bladder muscle. Stage 0 includes noninvasive papillary cancer and carcinoma in situ (CIS). In bladder cancer, CIS is a flat, high-grade cancer in the bladder lining.
Treatment commonly starts with TURBT. Depending on the tumor and its risk of coming back or progressing, treatment may include medicine placed directly into the bladder, such as chemotherapy or BCG immunotherapy.
Stage 1
Stage 1 bladder cancer has grown through the bladder lining into the connective tissue underneath, called the lamina propria. It has not reached the bladder muscle. This is still considered non-muscle-invasive bladder cancer.
Treatment usually includes TURBT, and higher-risk cancers often are treated with BCG. Radical cystectomy may be considered for some very high-risk cancers or cancer that persists or returns despite bladder-directed treatment.
Stage 2
Stage 2 bladder cancer has grown into the muscle layer of the bladder wall. The cancer has not spread to nearby lymph nodes or distant parts of the body. This is muscle-invasive bladder cancer.
For people who are able to have surgery, treatment commonly includes cisplatin-based chemotherapy before radical cystectomy. Another option for selected people is bladder-preserving therapy using TURBT, chemotherapy and radiation therapy.
Stage 3
Stage 3 bladder cancer has grown through the bladder muscle into tissue around the bladder. The cancer may have spread to nearby organs or lymph nodes.
Treatment depends on exactly where the cancer has spread and a person's overall health. Treatment may combine medicines that work throughout the body with radical cystectomy and lymph-node removal. For some people, treatment may include chemotherapy with radiation therapy.
Stage 4
Stage 4 bladder cancer is advanced cancer. It may have grown into the wall of the pelvis or abdomen. The cancer may have spread to lymph nodes beyond the pelvis or to distant organs. Common distant sites include the bones, lungs and liver.
Treatment usually uses medicines that work throughout the body. Treatment may help slow the cancer, ease symptoms and help people live longer. In some situations, radiation or surgery may be used to control symptoms or treat specific areas of cancer.
How fast does bladder cancer grow or spread?
How quickly bladder cancer grows or spreads varies. Low-grade cancers tend to grow more slowly and are less likely to invade the bladder muscle. High-grade cancers are more likely to grow into the muscle and spread.
Stage and grade describe different things. Stage describes where the cancer is in the body. Grade describes how the cancer cells look and gives clues about how quickly the cancer may grow or spread.