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Bladder Cancer Staging

Cancer Connect

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The UW Prostate and Genitourinary Cancer Program (UWPGCP) and the University of Wisconsin Carbone Cancer Center, the state's only comprehensive cancer center, take a multidisciplinary approach to treating bladder cancer.

 

Bladder Cancer Staging

 

Staging is the process of gathering information about cancerous tumors in the bladder to determine the proper course of treatment. The staging system most often used for bladder cancer is the TNM system:
  • The letter T is followed by a number from 1 to 4 to describe tumor growth and spread into surrounding tissue.
  • The letter N is followed by a number from 0 to 3 to indicate spread to lymph nodes.
  • The letter M is followed by 0 or 1 to indicate whether or not the cancer has spread to other organs or lymph nodes not near the bladder.

Primary Tumor (T) Staging

  • TX: No primary tumor can be assessed.
  • T0: No primary tumor can be seen.
  • Ta: Superficial cancer is found only in polyps (papillary) on the surface of the inner lining of the bladder.
  • Tis: Tumor is found only in flat lesions on the surface of the inner lining of the bladder.
  • T1: Tumor is found in the connective tissue below the lining of the bladder but has not spread to the bladder muscle.
  • T2: (a) Tumor has spread to the inner half of the smooth muscle layer (superficial layer) below the lining of the bladder, or (b) tumor has spread to the outer half of the muscle layer of the bladder.
  • T3: (a) Tumor has spread through the muscular wall of the bladder into the fatty tissue, or (b) tumor has spread through the muscular wall of the bladder into the fatty tissue and is visible to the eye.
  • T4: (a) Tumor has spread to the prostate in men or the uterus or vagina in women, or (b) tumor has spread to the pelvic or abdominal wall.

Lymph Node Involvement (N) Staging

  • NX: Lymph nodes in the pelvis cannot be assessed.
  • N0: No bladder cancer in lymph nodes.
  • N1: Bladder cancer is found in one lymph node and is two centimeters or smaller.
  • N2: Bladder cancer is found in one lymph node and is between two centimeters and five centimeters, or cancer is found in multiple lymph nodes but none are larger than five centimeters.
  • N3: Bladder cancer is found in one or more lymph nodes and is larger than five centimeters.

Metastasis (M) Staging

  • MX: Spread of cancer to other organs cannot be evaluated.
  • M0: No evidence of bladder cancer elsewhere in the body.
  • M1: Bladder cancer cells are found somewhere else in the body.

Stages of Bladder Cancer

 

Stage

TNM Classification

Description

 

0 (a)

 

Ta, N0, M0

Noninvasive papillary carcinoma, grown toward center of the bladder but has not grown into the muscle or connective tissue nor spread to lymph nodes or distant sites. 

0 (is)

Tis, N0, M0

Flat, noninvasive carcinoma (in situ or CIS), growing in the lining layer of the bladder but not inward toward the hollow part of the bladder nor in the muscle or connective tissue of the bladder wall, has not spread to lymph nodes or distant sites.  

I

T1, N0,M0

Grown into the connective tissue under the lining layer of the bladder but not the layer of muscle in the bladder wall nor into lymph nodes or distant sites. 

II

T2a, T2b, N0, M0

Grown into the muscle layer of the bladder wall but not completely through the muscle to reach the layer of fatty tissue that surrounds the bladder nor to lymph nodes or to distant sites. 

III

T3a, T3b, T4a, N0, M0

Grown completely through the bladder into the layer of fatty tissue that surrounds the bladder, may have spread into the prostate, uterus, or vagina but not into the pelvic or abdominal wall nor to lymph nodes or to distant sites. 

IV

T4b, N0, M0

Grown through bladder wall and into the pelvic or abdominal wall but not to lymph nodes or to distant sites. 

Any T, N1, N2, N3, M0

Spread to nearby lymph nodes but not to distant sites. 

Any T, any N, M1

Spread to distant sites (bones, liver or lungs) 

 

Bladder Cancer Grading

 

Grades refer to how the cancer cells look under a microscope. Bladder cancer cells are described as well differentiated, moderately differentiated, or poorly differentiated, with differentiation describing how clearly the cancer cells can be distinguished from the surrounding normal tissues and how normal or abnormal the cells look.

  • GX: Grade cannot be assessed.
  • G1: Well-differentiated cancers with clear boundaries and cells that look relatively normal. They usually do not grow and spread rapidly.
  • G2: Moderately differentiated cancers with abnormal looking cells and cell boundaries.
  • G3-4: Poorly differentiated cancers with less-clearly defined boundaries and cells that look abnormal. They often grow and spread rapidly.