Table of ContentsView AllTable of ContentsGradingTNM System of StagingStage 0Stage IStage IIStage IIIStage IVFrequently Asked QuestionsNext in Bladder Cancer GuideSigns and Symptoms of Bladder Cancer
Table of ContentsView All
View All
Table of Contents
Grading
TNM System of Staging
Stage 0
Stage I
Stage II
Stage III
Stage IV
Frequently Asked Questions
Next in Bladder Cancer Guide
When you are first diagnosed withbladder cancer, your doctors will perform tests to determine the stage and grade of your disease. The bladder cancer staging and grading processes help your doctors make treatment decisions and estimate your chance of recovery.
Verywell / Laura Porter
When doctors first diagnose a cancerous tumor of any kind, they assess how much it has grown, how far it has spread in the body, and how abnormal, or wild, the cancerous cells in the tumor look. These assessments are used to determine cancer’s stage (0 to IV) and grade.
Doctors use the staging information to comparetreatment optionsand patient outcomes. Staging and grading also important in determining your eligibility for cancer treatment clinical trials.
Early DetectionIf cancers are caught early, they are easier to treat and cure. When they’re caught later, after they’ve grown and spread, they’re more difficult to treat and more likely to be deadly.
Early Detection
If cancers are caught early, they are easier to treat and cure. When they’re caught later, after they’ve grown and spread, they’re more difficult to treat and more likely to be deadly.
This article will cover how bladder cancers are staged and graded, the bladder cancer staging system, and the stages of bladder cancer, as well as some frequently asked questions about bladder cancer staging.
Katleho Seisa / E+ / Getty Images
Bladder Cancer Grading
Doctors use a variety of tests todiagnose bladder cancerand determine its grade and stage. These include blood tests, imaging tests that look inside the body, and samples of the tumors called abladder biopsy, usually taken duringsurgery.
Symptoms of Bladder CancerSymptoms of bladder cancerare relatively common symptoms of various diseases and are easy to miss. The most common symptom of bladder cancer is reddish or brownish-colored urine from blood in the urine. Other symptoms include the frequent urge to urinate, pain while urinating, and pain in the back or pelvis.
Symptoms of Bladder Cancer
Symptoms of bladder cancerare relatively common symptoms of various diseases and are easy to miss. The most common symptom of bladder cancer is reddish or brownish-colored urine from blood in the urine. Other symptoms include the frequent urge to urinate, pain while urinating, and pain in the back or pelvis.
The TNM System of Bladder Cancer Staging
The TNM system has three parts:
MetastasisThe cancer spreads from the original location through a process calledmetastasis. When cancer spreads, it’s called metastatic cancer or a metastatic tumor. This spreading can happen between tissues, or through the fluids of the blood or lymphatic systems.
Metastasis
The cancer spreads from the original location through a process calledmetastasis. When cancer spreads, it’s called metastatic cancer or a metastatic tumor. This spreading can happen between tissues, or through the fluids of the blood or lymphatic systems.
T scoring is from 0 to 4, and also special categories of Ta and Tis. N is scored from 0 to 3. M is either 0 or 1. An X means that that characteristic couldn’t be measured.
Stage Never ChangesA cancer stage never changes from when it was first diagnosed. If cancer improves or worsens, it will be the same stage cancer.
Stage Never Changes
A cancer stage never changes from when it was first diagnosed. If cancer improves or worsens, it will be the same stage cancer.
Stage 0 Bladder Cancer
Stage zero bladder cancers are called noninvasive papillary carcinoma and carcinoma in situ. They’re precancerous lesions that could develop into more serious cancers if not treated.
These growths develop on the inner lining of the bladder. Noninvasive papillary carcinoma, also called stage 0a, forms long, thin growths into the empty space inside the bladder.
Carcinoma in situ, also called stage 0is bladder cancer, forms flatter growths that tend to be of a wilder “grade.” It is considered a more aggressive disease and is more likely to spread into the muscular walls of the bladder.
According to the National Cancer Institute’s SEER database of cancer statistics, about half (51%) of bladder cancers are diagnosed at stage 0.
Treatment
Stage 0 bladder cancer is typically successfully treated with a surgery called transurethral resection (TUR) with fulguration.
The surgery uses a lighted camera that is threaded up theurethra—the tube through which urine usually exits the body. The tube has tools on it that let the surgeon remove the tumor, take a biopsy sample, and burn away any remaining cancerous cells, a procedure known asfulguration.
Surgery is typically followed up with chemotherapy inside the bladder or an immunotherapy calledBacillus Calmette-Guerin (BCG) therapy. When treatment is given into the bladder, it’s called intravesically administered treatment.
BCG is a unique immunotherapy treatment that uses germs related to those that cause tuberculosis to activate your body’s immune response and attack bladder cancer.
If BCG therapy is unsuccessful, another treatment option includes Adstiladrin (nadofaragene firadenovec-vncg). Adstiladrin is the first gene therapy approved for adults with high-risk, non-muscle invasive bladder cancer that hasn’t responded to BCG therapy, the standard treatment.
Stage I Bladder Cancer
Stage I bladder cancers are cancerous tumors that have spread from the inner layer of the bladder into the connective tissue layer just under it.
These tumors haven’t yet reached the muscular layers of the bladder, so they’re often called non-muscle-invasive bladder cancer. Some cases of non-muscle-invasive bladder cancer progress to muscle-invasive bladder cancer, which is more serious.
According to SEER, a third (34%) of bladder cancers are diagnosed when they’re local, when they haven’t spread beyond the organ they developed in, stage I and II.
Stage II Bladder Cancer
Stage II bladder cancer is also known as muscle-invasive bladder cancer. These tumors have spread into the muscular walls of the bladder. Stage II cancers are more likely to spread to other parts of the body.
Approximately 20% of newly diagnosed bladder cancer cases are muscle-invasive.
Muscle-Invasive TumorsHow far the tumor has invaded into the muscular wall of the bladder plays a central role in staging. Cancers that have grown into the bladder wall (muscle-invasive tumors) generally have poorer outcomes. The same applies to having larger tumors or numerous tumors.
Muscle-Invasive Tumors
How far the tumor has invaded into the muscular wall of the bladder plays a central role in staging. Cancers that have grown into the bladder wall (muscle-invasive tumors) generally have poorer outcomes. The same applies to having larger tumors or numerous tumors.
Stage II and stage III bladder cancer are typically treated with surgeries to remove all or part of the bladder and any local tissues that cancer may have spread to. Some patients may only need a partial removal of the bladder or TUR and fulguration.
Sometimes treatments like chemotherapy and external-beam radiation therapy are also used. If chemotherapy is recommended to shrink the bladder tumors before surgery, it’s referred to asneoadjuvant therapy.
Stage III Bladder Cancer
Stage III bladder cancers have started to spread away from the bladder itself into either local or regional organs or into lymph nodes in the pelvis. It’s divided into stage IIIA and stage IIIB.
Stage IIIA bladder cancer has either:
Stage IIIB cancer has also spread. To be defined as stage IIIB, cancer needs to be found in either:
According to SEER, 7% of bladder cancer cases are diagnosed when they’ve reached stage III, or “regional” stage.
Stage IV Bladder Cancer
Stage IV cancer has metastasized or spread to major organs in other parts of the body. This is often called metastatic cancer. About 5% of bladder cancer cases are diagnosed after they’ve already spread to distant organs, according to SEER.
Stage IV bladder cancer is divided into stage IVA and IVB. IVA cancer has spread either:
IVB bladder cancer has spread to other organs, which can include the lungs, bones, and liver.
When a patient is diagnosed with stage IV ormetastatic bladder cancer, doctors will likely use a combination of chemotherapy, surgery, immunotherapy, and radiation to reduce symptoms and prolong life.
Coping
Late-stage bladder cancer doesn’t have very good outcomes. According to SEER, if bladder cancer has metastasized before it is detected, there’s only about a 6.4% chance of a patient surviving five years after being diagnosed.
New types and combinations of treatment for bladder cancer are being tested in clinical trials. Talk to your doctor about your options and be honest with your care team about your thoughts and feelings—they’re there to help make the best decisions and provide the best options for you.
Summary
A Word From Verywell
Bladder cancer is relatively common, coming in as the sixth most common cancer. According to the Centers for Disease Control and Prevention (CDC), bladder cancer is diagnosed in 56,000 men and 17,500 women every year, and about 12,000 men and 4,700 women die from the disease annually.
The good news is that most bladder cancers are highly treatable—the average five-year survival rate is quite high at 76.9%. This rate has improved over the past several years.
Frequently Asked QuestionsMany bladder cancers that are initially discovered in stage 0 or I are treated successfully and do not progress to more advanced cancers. Cancers that are diagnosed in stage II or later are more likely to continue growing or spreading, or recur after initial treatment.As bladder cancer becomes more advanced, it spreads first to the muscular wall of the bladder, then into either the abdomen, pelvis, or local lymph nodes. When bladder cancer has become metastatic, it spreads to the lungs, bones, or liver.Learn MoreBladder Cancer Stages, Prognosis, and Survival Rates
Many bladder cancers that are initially discovered in stage 0 or I are treated successfully and do not progress to more advanced cancers. Cancers that are diagnosed in stage II or later are more likely to continue growing or spreading, or recur after initial treatment.
As bladder cancer becomes more advanced, it spreads first to the muscular wall of the bladder, then into either the abdomen, pelvis, or local lymph nodes. When bladder cancer has become metastatic, it spreads to the lungs, bones, or liver.Learn MoreBladder Cancer Stages, Prognosis, and Survival Rates
As bladder cancer becomes more advanced, it spreads first to the muscular wall of the bladder, then into either the abdomen, pelvis, or local lymph nodes. When bladder cancer has become metastatic, it spreads to the lungs, bones, or liver.
Learn MoreBladder Cancer Stages, Prognosis, and Survival Rates
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Anatomy of the bladderNational Cancer Institute.Cancer staging.National Cancer Institute.Bladder cancer treatment (adult) (PDQ®)–patient version.Centers for Disease Control and Prevention.Bladder cancer basics.American Society of Clinical Oncology.Bladder cancer stages.National Cancer Institute.Cancer—cancer stat facts. 2021National Cancer Institute.Bladder cancer treatment (PDQ®)–health professional version.Patel VG, Oh WK, Galsky MD. Treatment of muscle-invasive and advanced bladder cancer in 2020. CA Cancer J Clin. 2020 Sep;70(5):404-423. doi: 10.3322/caac.21631
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.Anatomy of the bladderNational Cancer Institute.Cancer staging.National Cancer Institute.Bladder cancer treatment (adult) (PDQ®)–patient version.Centers for Disease Control and Prevention.Bladder cancer basics.American Society of Clinical Oncology.Bladder cancer stages.National Cancer Institute.Cancer—cancer stat facts. 2021National Cancer Institute.Bladder cancer treatment (PDQ®)–health professional version.Patel VG, Oh WK, Galsky MD. Treatment of muscle-invasive and advanced bladder cancer in 2020. CA Cancer J Clin. 2020 Sep;70(5):404-423. doi: 10.3322/caac.21631
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Cancer Institute.Anatomy of the bladderNational Cancer Institute.Cancer staging.National Cancer Institute.Bladder cancer treatment (adult) (PDQ®)–patient version.Centers for Disease Control and Prevention.Bladder cancer basics.American Society of Clinical Oncology.Bladder cancer stages.National Cancer Institute.Cancer—cancer stat facts. 2021National Cancer Institute.Bladder cancer treatment (PDQ®)–health professional version.Patel VG, Oh WK, Galsky MD. Treatment of muscle-invasive and advanced bladder cancer in 2020. CA Cancer J Clin. 2020 Sep;70(5):404-423. doi: 10.3322/caac.21631
National Cancer Institute.Anatomy of the bladder
National Cancer Institute.Cancer staging.
National Cancer Institute.Bladder cancer treatment (adult) (PDQ®)–patient version.
Centers for Disease Control and Prevention.Bladder cancer basics.
American Society of Clinical Oncology.Bladder cancer stages.
National Cancer Institute.Cancer—cancer stat facts. 2021
National Cancer Institute.Bladder cancer treatment (PDQ®)–health professional version.
Patel VG, Oh WK, Galsky MD. Treatment of muscle-invasive and advanced bladder cancer in 2020. CA Cancer J Clin. 2020 Sep;70(5):404-423. doi: 10.3322/caac.21631
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
