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  • Staging and prognosis of bladder cancer

    Last reviewed May 2012

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    Staging

    To help plan the best treatment for bladder cancer, tumours are given a stage to describe the extent of the cancer in the body.

    The most common staging system is known as the TNM system. In this system, letters are assigned numbers to describe the cancer:

     

    T = Tumour

    Indicates the size and depth of tumour invasion into the bladder and nearby tissues.

    • Ta – non-invasive papillary tumour
    • Tis – carcinoma in-situ
    • T1 – the tumour is in the connective tissue
    • T2 – the tumour is in the lamina propria
    • T3 – the tumour is in the tissue surrounding the bladder (perivesical tissue)
    • T4 – the tumour has invaded nearby structures such as the pelvic wall, seminal vesicles or uterus
    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 is in one lymph node in the pelvis
    • N2 – the cancer is in multiple lymph nodes in the pelvis
    • N3 – the cancer has spread to lymph nodes located near a major artery
    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

    The stage can also be described using numbers:

    • Stage 0a – There is a small area of cancer in the bladder lining that has not spread.
    • Stage 0is (carcinoma in-situ) – A flat tumour confined to the lining of the bladder which is almost always high grade.
    • Stage 1 – Cancer has spread into the connective tissue.
    • Stage 2 – Cancer is in the muscle of the bladder wall under the connective tissue.
    • Stage 3 – The cancer has grown through the layer of muscle in the bladder and into surrounding fat. It may have spread to nearby organs such as the prostate or vagina.
    • Stage 4 – The cancer has spread throughout the body to the wall of the abdomen or pelvis, lymph nodes, bones and other organs.

    Grading

    Grading describes how aggressive the cancer cells are:

    • Low grade – The cancer cells look fairly normal and behave similarly to healthy cells. The cells tend to grow slowly. Most bladder tumours are low grade.
    • High grade – The cancer cells look very abnormal and grow in a disorderly way. These cells tend to grow very quickly.

    Bladder cancer can also be graded on a scale of 1–3. Grade 1 cancers are the slowest growing and grade 3 cancers are the most aggressive.

    Prognosis

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

    Test results, the type of cancer you have, its stage and grade, how well you respond to treatment and other factors such as age and medical history are important factors in assessing your prognosis.

    Bladder cancer can usually be effectively treated especially if it is found early, before it spreads outside the bladder.

    Information reviewed by: Dr Paul Gassner, VMO Uro-oncological Surgeon at Bankstown, Liverpool and Shoalhaven Hospitals, NSW; David Connah, Cancer Council Connect Consumer Volunteer; Virginia Ip, Urology Care Coordinator, Sydney Cancer Centre, Royal Prince Alfred Hospital, NSW; Samantha Kelaher, Cancer Council Helpline Consultant, Cancer Council NSW; and Gary Schoer, Cancer Council Connect Consumer Volunteer.

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