Staging and grading for early bladder cancer

Staging

The stage of a cancer describes its size and whether it has spread. Although test results provide a lot of information, the exact stage of the cancer won’t be known until after surgery to remove it.

Once your doctors know the stage of the bladder cancer, they can decide on the most appropriate treatment for you.

The most commonly used staging system is the TNM system:

• T is the size of the tumour (cancer).
• N is whether it has spread to the nearby lymph nodes (sometimes called glands).
• M is whether the cancer has spread to other parts of the body (metastases).

Non-invasive bladder cancer has not spread to the lymph nodes or to other parts of the body.

Stages of non-invasive bladder cancer

Non-invasive bladder cancer will be staged as CIS, Ta or T1:

• Carcinoma in situ (CIS) This is sometimes described as a flat tumour. Cancer cells are only in the very inner layer of the bladder lining.
• Ta The cancer is a mushroom-like growth (papillary cancer) growing only in the inner layer of the bladder lining.
• T1 The cancer has started to grow into the layer of connective tissue beneath the bladder lining.

 

Grading

The grade of a cancer gives an idea of how quickly it might grow. Bladder cancer is graded according to how the cancer cells| look when the biopsy sample is examined under a microscope. Knowing the grade of a cancer helps your urologist decide if you need treatment after surgery|.

• Grade 1 or low-grade - The cancer cells look very much like normal bladder cells, are usually slow-growing and less likely to spread.
• Grade 2 or intermediate-grade - The cancer cells look more abnormal and grow slightly more quickly than grade 1 cancers.
• Grade 3 or high-grade - The cancer cells look very abnormal and are more likely to grow more quickly.

Carcinoma in situ (CIS) is always classed as high-grade.