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The staging, grading and prognosis of bladder cancer

Staging

The tests completed by your doctors work out whether you have bladder cancer and whether it has spread into the muscle layer of the bladder or to other parts of the body. This testing process is called staging.

The most common staging system for bladder cancer is the TNM system. In this system, letters and numbers are used to describe the cancer, with higher numbers indicating larger size or spread.

T stands for tumourTa, Tis and T1 are non-muscle-invasive bladder cancer, while T2, T3 and T4 are muscle-invasive bladder cancer.
N stands for nodesN0 means the cancer has not spread to the lymph nodes, while N1, N2 and N3 indicate that it has spread to lymph nodes.
M stands for metastasisM0 means the cancer has not spread to distant parts of the body, while M1 means it has spread to distant parts of the body.

Some doctors put the TNM scores together to produce an overall stage, from stage 1 (earliest stage) to stage 4 (most advanced).

Grade and risk category

The biopsy results will show the grade of the cancer. This is a score that describes how quickly a cancer might grow. Knowing the grade helps your urologist predict how likely the cancer is to come back (recur) and if you will 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 prompt treatment to prevent it invading the muscle layer.

Risk category – Based on the stage, grade and other features, a non-muscle-invasive bladder cancer will also be classified as having a low, medium or high risk of returning after treatment. This will help your doctors work out which treatments to recommend.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.

To work out your prognosis, your doctor will consider test results, the type of bladder cancer, the stage, grade and risk category, how well you respond to treatment, and factors such as your age, fitness and medical history. Bladder cancer can usually be effectively treated, especially if it is found early. As in most types of cancer, the results of bladder cancer treatment tend to be better when the cancer is found and treated early.

This information is reviewed by

This information was last reviewed in February 2020 by the following expert content reviewers: Prof Dickon Hayne, UWA Medical School, The University of Western Australia, and Head, Urology, South Metropolitan Health Service, WA; BEAT Bladder Cancer Australia; Dr Anne Capp, Senior Staff Specialist, Radiation Oncology, Calvary Mater Newcastle, NSW; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Peter Heathcote, Senior Urologist, Princess Alexandra Hospital, and Adjunct Professor, Australian Prostate Cancer Research Centre, QLD; Melissa Le Mesurier, Consumer; Dr James Lynam, Medical Oncologist Staff Specialist, Calvary Mater Newcastle and The University of Newcastle, NSW; John McDonald, Consumer; Michael Twycross, Consumer; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria.