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Staging and Grading

Bladder Cancer Staging

Staging of any kind of cancer is an indication of advanced is the cancer.  During the early stages of any cancer, the tumor is confined to the organ in which it began.  In terms of bladder cancer, the early stage indicates that the cancer has arisen from the bladder and is confined to the bladder.  Late stage bladder cancer indicates spread of the cancer to other areas of the body.  Like other types of cancer, bladder cancer has much better prognosis and chance of cure in its early stage.

Stage 0: The cancer has grown along the inner bladder lining, known as the mucosa.  This cancer is also known as superficial cancer and has not invaded into the deeper layers of the bladder wall.

Stage I: The cancer has grown into the connective tissue (Lamina Propria layer) underneath the bladder lining (mucosa) but has not reached the layer of muscle in the bladder wall.  The cancer has not spread to the lymph nodes or to other areas of the body.

Stage II: The cancer has grown into the bladder wall's muscle layer, but has not passed all the way through the muscle to the fatty tissue surrounding the bladder.  The cancer has not spread to the lymph nodes or to other areas of the body.

Stage III: The cancer has grown completely through the bladder and into the fatty tissue surrounding the bladder.  It may have spread to nearby organs including the prostate, uterus or vagina, but is not growing into the pelvic or abdominal wall.  The cancer has not spread to the lymph nodes or to other areas of the body.

Stage IV: In this stage, the cancer has either grown through the bladder wall and into the pelvic or abdominal walls, but hasn't spread to other areas of the body, or, the cancer has spread to nearby lymph nodes, but not other parts of the body, or, the cancer has spread to distant sites such as the lungs, bones or liver.

Stage

Description

T0

Tumor is confined the layer of cells lining the bladder called the Mucosa

T1

Tumor has grown from layer of cells lining the bladder into connective tissue below it (Lamina Propria Invasion). It has not grown into the bladder muscle.

T2

Tumor has grown into muscle layer

T2a

Tumor has grown into inside 1/2 of muscle layer

T2b

Tumor has grown into outer 1/2 of muscle layer

T3

Tumor has grown through bladder muscle layer and into fatty tissue surrounding bladder

T3a

Spread of tumor to fatty tissue outside bladder can only be seen via microscope

T3b

Spread of tumor to fatty tissue outside bladder large enough to be seen on imaging exams, or to be seen or felt by the physician

T4

Tumor has spread beyond bladder's fatty tissue and into organs nearby: stoma, prostate, seminal vesicles, uterus, vagina, pelvic wall, or abdominal wall.

T4a

Tumor has spread to stoma of the prostate in men or the uterus and/or vagina in women.

T4b

Tumor has spread to pelvic or abdominal wall.

Node (N)

Lymph nodes near the bladder

N0

No lymph node (LN) metastasis

N1

Tumor has spread to one lymph node inside the pelvis

N2

Tumor has spread to two or more lymph nodes inside the pelvis

N3

Tumor has spread to lymph nodes along the iliac artery

Metastasis (M)

Tumor spread to distant sites

M0

No distant metastasis to lymph nodes or other organs

M1

Distant metastasis present; includes spread to distant lymph nodes and/or other organs; lung, bones, liver

Relationship between TNM Prostate Cancer Staging and Stage
Categories I to IV:

Stage

T

N

M

I T1 N0 M0
II T2 ot Tb N0 M0
III T3, T3b or t4a N0 M0
IV T4

N0 — N3

M0 — M1

Any T

N0 — N3

M1

Survival & Stage

For comparison purposes, the below statistics from the National Cancer Institute are based on "relative survival." This means they are a comparison of the general population to bladder cancer patients at various stages of disease.  The overall 5-year relative survival for 2002-2008 from 18 SEER geographic areas was 77.7%. Five-year relative survival by race and sex was: 79.8% for white men; 73.1% for white women; 69.7% for black men; 54.3% for black women.

Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
2002-2008, All Races, Both Sexes

Stage at Diagnosis

Stage
Distribution (%)

5-year
Relative Survival (%)

Localized (confined to primary site)

35 70.2%

Regional (spread to regional lymph nodes)

7 32.9%

Distant (cancer has metastasized)

4 5.5%

Unknown (unstaged)

3 48.8%

Bladder Cancer Grading

Grading of any kind of cancer indicates the degree of aggressiveness of the cancer cells.  The grade of cancer is determined by microscopic features of the cancer cells.  The higher the grade of the cancer, the faster it can grow and spread.  Bladder cancer has two grades: Low Grade and High Grade.  In general, tumors that are Low Grade tend to be superficial, rarely invade the deeper layers of the bladder and rarely spread to other organs.  Tumors that are high grade have a higher chance of invasion into the deep layers of bladder muscle, a higher chance of recurrence, and a higher chance of spread to other organs in the body.

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