Staging and prognosis for bladder cancer

Once you have had tests that show you have bladder cancer and whether it has spread, your doctor will tell you the stage of the cancer. This staging helps the doctor decide on the best treatment for you.

The expected outcome of your disease is called the prognosis, but it is only a prediction and some people do not find it helpful or even prefer not to know.

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Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of the disease. Bladder cancer can usually be effectively treated, especially if it is found before it spreads outside the bladder.

To work out your prognosis, your doctor will consider test results, the type of bladder cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as your age, fitness and medical history.

Staging bladder cancer

To help plan treatment, tumours are given a stage to describe the extent of the cancer in the body. The most common staging system for bladder cancer is the TNM system.

TNM staging

T (Tumour)

Describes how far the tumour has grown into the wall of the bladder and nearby tissues.

  • Ta – non-invasive papillary tumour (finger-like growth from the urothelium or bladder lining)
  • Tis – carcinoma in situ (flat tumour in the urothelium)
  • T1 – tumour is in the lamina propria (layer of tissue and blood vessels surrounding the urothelium)
  • T2 – tumour is in the muscularis propria (muscular layer surrounding the bladder)
  • T3 – tumour is in the layer of perivesical tissue (fat)
  • T4 – tumour has spread beyond bladder, e.g. to prostate, uterus, vagina or pelvic wall

N (Nodes)

Shows if the cancer has spread to nearby lymph nodes.

  • N0 –  the cancer has not spread to the lymph nodes
  • N1 – the cancer has spread to one lymph node in the pelvis
  • N2 – the cancer has spread to multiple lymph nodes in the pelvis
  • N3 – the cancer has spread to lymph nodes in the abdomen

M (Metastasis)

Shows if the cancer has spread to other parts of the body.

  • M0 – cancer has not spread to distant parts of the body
  • M1 – cancer has spread to distant parts of the body, such as the liver

In this system, letters are assigned numbers to describe the cancer – Ta, Tis and T1 are considered non-muscle-invasive bladder cancer, while T2, T3 and T4 are muscle-invasive bladder cancer.

Another way of staging cancer is with numbers. There are four main stages: stage 1 is the earliest cancer and stage 4 is the most advanced.However, this method is not used often for bladder cancer.

Grading bladder cancer

The biopsy results will also tell your doctor about the grade of the cancer. This describes how quickly a cancer might grow. Knowing the grade helps your specialist predict how likely the cancer is to come back (recur) and if you need further treatment after surgery.

Low grade – The cancer cells look similar to normal bladder cells, are usually slow-growing and are less likely to invade and spread. Most bladder tumours are low grade.

High grade – The cancer cells look very abnormal and grow quickly. They are more likely to spread both into the bladder muscle and outside the bladder.

In non-muscle-invasive tumours, the grade may be low or high, while almost all muscle-invasive cancers are high grade.

Carcinoma in situ (stage Tis in the TNM system) is a high-grade tumour that needs immediate, and sometimes aggressive, treatment to prevent it invading the muscle layer.

This information was last reviewed in February 2018
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