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The staging, grading and prognosis of bladder cancer

Staging

The tests completed by your doctors help show whether you have bladder cancer, how far the cancer has grown into the layers of the bladder, and whether there are any signs of cancer outside the bladder. This is called staging. Your doctor may describe the cancer as:

Non-muscle-invasive bladder cancer (NMIBC) – The cancer cells are found only in the inner lining of the bladder (urothelium) or the next layer of tissue (lamina propria) and haven’t grown into the deeper layers of the bladder wall.

Muscle-invasive bladder cancer (MIBC) – The cancer has spread beyond the urothelium and lamina propria into the layer of muscle (muscularis propria), or sometimes through the bladder wall into the surrounding fatty tissue. These cancers can also sometimes spread to lymph nodes close to the bladder.

Advanced bladder cancer – The cancer has spread (metastasised) outside of the bladder into distant lymph nodes or other organs of the body.

TNM staging system

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; N1, N2 and N3 indicate it has spread to lymph nodes.
M stands for metastasisM0 means the cancer has not spread to distant parts of the body; 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 and are usually slow-growing. They are less likely to invade and spread.

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 cancers, 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 to be treated quickly 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 lower or higher risk of returning after treatment or spreading into the muscle layer. Knowing the risk category 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.

In general, the earlier bladder cancer is diagnosed, the better the outcome. To work out your prognosis, your doctor will consider:

  • your test results
  • the type of bladder cancer
  • the stage, grade and risk category
  • how well you respond to treatment
  • other factors such as your age, fitness and medical history.

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This information is reviewed by

This information was last reviewed in February 2022 by the following expert content reviewers: Prof Dickon Hayne, Professor of Urology, UWA Medical School, The University of Western Australia, Chair of the Bladder, Urothelial and Penile Cancer Subcommittee, ANZUP Cancer Trials Group, and Head of Urology, South Metropolitan Health Service, WA; A/Prof Tom Shakespeare, Director, Radiation Oncology, Coffs Harbour, Port Macquarie and Lismore Public Hospitals, NSW; Helen Anderson, Genitourinary Cancer Nurse Navigator (CNS), Gold Coast University Hospital, QLD; BEAT Bladder Cancer Australia; Mark Jenkin, Consumer; Dr Ganessan Kichenadasse, Lead, SA Cancer Clinical Network, Commission of Excellence and Innovation in Health, and Medical Oncologist, Flinders Centre for Innovation in Cancer, SA; A/Prof James Lynam, Medical Oncology Staff Specialist, Calvary Mater Newcastle, NSW; Jack McDonald, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Tara Redemski, Senior Physiotherapist – Cancer and Blood Disorders, Gold Coast University Hospital, QLD; Prof Shomik Sengupta, Consultant Urologist, Eastern Health and Professor of Surgery, Eastern Health Clinical School, Monash University, VIC.