What Are the Stages of Bladder Cancer?
The stages of bladder cancer are used to describe how far the cancer has spread in your body. The higher the stage number, the more widespread the cancer is. These stages are important when choosing the best treatments for you. Bladder cancer is usually found in an early stage, either stage 0 or stage I.
TNM System
One way to describe the stages of bladder cancer is to use the TNM system. This system uses three different codes to describe how far the tumor has gone through the layers of the bladder wall, whether it has spread to the lymph nodes around the tumor, and whether it can be found in other parts of the body.
In the TNM system, "T" plus a letter or number (0 to 4) is used to describe the depth of the tumor in the bladder lining. The tumor stages are:
TX - The primary, or original, tumor cannot be evaluated because of incomplete information.
T0 - No evidence of bladder cancer.
Ta - Noninvasive papillary carcinoma.
Tis - The cancer is found only in the layer of cells closest to the inside or hollow part of the bladder. This type of tumor is known as carcinoma in situ (CIS) or noninvasive flat carcinoma.
T1 - Tumor has grown beyond the urothelial lining but not into the muscle layer.
T2 - Tumor has grown into the muscle layer (T2 is subdivided into T2a and T2b.)
- T2a - Tumor has grown into the inner half of the muscle layer.
- T2b - Tumor has grown into the outer half of the muscle layer.
T3 - Tumor has grown into the fatty tissue that surrounds the bladder (T3 is subdivided into T3a and T3b.)
- T3a - The spread to fatty tissue surrounding the bladder can only be seen by using a microscope.
- T3b - The spread to fatty tissue surrounding the bladder is large enough to be seen on imaging tests or to be seen or felt by the surgeon.
T4 - Tumor has spread to the prostate, uterus, vagina, pelvic wall, or abdominal wall (T4 is subdivided into T4a and T4b.)
- T4a - Tumor has spread to the prostate, uterus, and/or vagina.
- T4b - Tumor has spread to the pelvic or abdominal wall.
The "N" in the TNM system stands for node. Lymph nodes are tiny organs shaped like beans that can be found throughout the body. Lymph nodes help the body fight infections. Regional lymph nodes are near the bladder, while distant lymph nodes are in other parts of the body. Lymph node stages are:
NX - The regional lymph nodes cannot be evaluatedbecause of incomplete information.
N0 - The cancer has not spread into the regional lymph nodes.
N1 - The cancer has spread to one lymph node in the pelvis.
N2 - The cancer has spread to more than one lymph node in the pelvis.
N3 - The tumor has spread to common iliac lymph nodes.
The "M" in the TNM system is used for cancer that has spread, or metastasized, to other parts of the body. The stages for metastatic bladder cancer are:
MX - Distant metastasis cannot be evaluated because of incomplete information.
M0 - The cancer has not metastasized, or spread, to distant organs (such as the lungs or bones.)
M1 - The cancer has spread to other parts of the body beyond the bladder.
Cancer Stages 0-IV
The T, N, and M classifications are often grouped together into the following stages:
Stage 0 - The cancer involves only the innermost layers of the bladder. The cancer cells are grouped together (noninvasive papillary carcinoma, Stage 0a) or involve only the cells closest to the inside or hollow part of the bladder (carcinoma in situ, Stage 0is). Both noninvasive papillary carcinoma and carcinoma in situ are classified as superficial (Ta or Ti, N0, M0).
Stage I - The cancer cells have penetrated the bladder’s inner lining. The cancer has not invaded the bladder muscle or spread to lymph nodes. Stage I cancer is classified as superficial (T1, N0, M0).
Stage II - The cancer cells have spread into the bladder muscle wall. The cancer has not spread outside the bladder wall or to local lymph nodes. Stage II bladder cancer is classified as deep or invasive (T2a or T2b, N0, M0).
Stage III - The cancer cells have invaded through and beyond the bladder wall. The cancer cells may also have invaded the prostate gland in men or the uterus and/or vagina in women. The cancer has not spread to lymph nodes or distant organs. Stage III bladder cancer is classified as deep or invasive (T3a, T3b, or T4a; N0; M0).
Stage IV - The cancer cells have spread through the bladder wall and into the pelvic and/or abdominal wall. The cancer may have spread to lymph nodes or distant organs, such as the bones, liver, or lungs (T4b, N0, M0; any T, any N, M0; or any T, any N, M1).
Recurrent bladder cancer - Bladder cancer cells have returned after the cancer was successfully treated. The cancer might come back in its original location or in another part of the body.
This content has been reviewed and approved by Myo Thant, MD.
This content was last reviewed
August 15, 2010 by Dr. Reshma L. Mahtani.