The Different Stages of Bladder Cancer

What Are the Different Stages of Bladder Cancer?

When coming up with a suitable treatment process with a doctor, you begin by staging your disease. Staging bladder cancer is one of the most critical factors considered when making decisions on treatment options. Your health care providers use different diagnostic tests to analyze and evaluate your bladder cancer to determine an optimal treatment plan. If you have been diagnosed with bladder cancer, you should visit a pathologist to confirm whether the staging information you received was accurate and correct.

Health care professionals can describe bladder cancer by its stages. This is done by comparing cancerous and healthy cells. If your cancer cells closely resemble those of normal cells, the stage of cancer is regarded as less aggressive, or low grade. This means that its chances of metastasis after first treatment are low. If the cancerous cells are unhealthy and disorganized, judging from their appearance, the stage is said to be high grade.

TNM Staging System

One major tool your doctors will use to determine the stage of your bladder cancer is the TNM staging system. The abbreviated letters of the TNM system help answer the following questions:

• T (Tumor): What is the size of the primary bladder tumor? What is its location?
• N (Node): How many lymph nodes have been invaded by the cancer?
• M (Metastasis): Has the bladder cancer spread to other body parts?

The answers from the above questions are combined to come up with a particular stage of cancer for every patient. The TNM system helps doctors with communication during bladder cancer treatment. There are 5 stages of bladder cancer, named from stage 0 to stage 4. Each stage has a common name used to describe the cancer.

Below is a detailed explanation of each letter of the TNM staging system:

Tumor (T)

When using the TNM system to stage bladder cancer, the letter "T" plus a number or a letter is used to describe the location and size of your tumor. Some cancer stages are subdivided into smaller groups to help provide a clear detail of the tumor. If you have more than one tumor, a lowercase letter “m” is added to the letter “T” category. A list of every tumor stage is given below:

TX: This means that the stage of the primary cancer cannot be evaluated due to lack of information.

T0: This means that the bladder has no evidence to provide for the primary tumor.

Ta: This stage of cancer is called noninvasive papillary carcinoma. The type of growth at this stage is found at a very small section, which can be successfully removed through TURBT. However, recurrence chances of this are high.

Tis: This stage of bladder cancer is referred to as carcinoma in situ (CIS). This type of cancer is found only on the surface or near the surface of the bladder. Some doctors may call it superficial or non-muscle invasive bladder cancer. This is a stage or type of bladder cancer which has high chances of recurrence, even after treatment.

T1: This means that the tumor has spread to the connective tissue with less or no involvement of the bladder wall muscle. The bladder wall muscle, also called the lamina propria, lies inside the bladder lining.

T2: This means that the tumor has spread to the bladder wall muscle  

T2a: At this stage, the tumor has spread to the inner layer of your bladder wall muscle also called superficial muscle.

T2b: The tumor has spread deeply to your bladder wall muscles.

T3: The tumor has spread to the perivesical tissue. This is a fatty tissue surrounding the bladder.

T3a: It is similar to T3, but the cancerous cells grown on the perivesical tissue are visible on a microscope

T3b: The tumor has microscopically grown enough in the perivesical tissue that it can be seen during the imaging tests.

T4: The tumor at this stage has spread to the abdominal wall, prostate, uterus, vagina, pelvic wall, and abdominal wall.

T4a: The tumor at this stage has spread to the vagina, uterus and prostate.

T4b: At this stage, the tumor has spread up to the abdominal wall and pelvic girdle.

Node (N)

In TNM staging system letter "N" means that the cancer has spread to the lymph nodes. The lymph nodes near the origin of the cancer such as presacral, obturator, perivesical, and hypogastric lymph nodes are referred to as the regional lymph nodes. Those that are found in other parts, which are not close to the bladder, are called distant lymph nodes.

NX: This stage means that the regional lymph nodes lack enough information for cancer evaluation.

N0: This means that the cancer has not yet spread to the regional lymph nodes.

N1: This cancer has spread to at least one regional lymph node around the bladder.

N2: The cancer at this stage has spread to many lymph nodes on the pelvis.

N3: The cancer at this stage has spread to distant lymph nodes, such as iliac lymph nodes.

Metastasis (M)

In the TNM staging system, the letter ""” stands for metastasis. This means that the cancer has spread to other body organs near and far from the bladder.

M0: This means that the cancer has not yet undergone metastasis.

M1: Means that metastasis has travelled a long distance from the bladder.

Grouping Cancer Stages

Further grouping of the stages of bladder cancer is done by combination of the classes of the TNM. The groups are as follows:

Stage 0a: This is an early stage of cancer which can only be found on the surface of the bladder's inner lining. The cancerous cells are well grouped together, so that they can be removed easily with TURBT. This cancer has not spread to the muscles and connective tissue on the bladder wall. It is also called urotherial carcinoma (Ta, N0, M0).

Stage 0is: This stage is also known as carcinoma in situ (CIS). This stage of bladder cancer is only found on the bladder's inner lining. It has not yet spread into the bladder muscle wall and connective tissue (Tis, N0, M0).

Stage 1: This cancer has spread to the connective tissue found under the bladder's inner lining (T1, N0, M0).

Stage 2: This cancer has spread up to the thick muscle layer found on the bladder wall, but has not yet entered the muscle (T2, N0, M0).

Stage 3: In this stage, the cancer has entered the fatty tissue around the bladder and is almost near organs such as the vagina and prostate. However, this cancer has not reached the pelvic wall and lymph nodes (T3 or T4a, N0, M0).

Stage 4: This cancer has the following characteristics:

• It has entered the pelvic wall and not the lymph nodes (T4b, N0, M0).
• Has spread to many regional lymph nodes and not other body parts (T, N1-3, M0).
• The cancer has spread to other body parts or organs (T, any N, M1).

The Bottom Line

Since different medications work best at different stages of your bladder cancer, it is important to identify different stages of your cancer. Doctors use different diagnostic tests to tell the difference between your healthy cells and cancerous cells. All these properties are brought together to stage your bladder cancer.