Staging and grading

The stage of the cancer describes the size of the tumour and whether it has spread. The doctors will find out the stage of the cancer after you’ve had surgery to remove it. This helps with decisions about treatment.

The grade of a cancer tells the doctors how quickly it might grow.

The most common system used to describe the stage of a bladder cancer is the TNM system:

  • T describes how far the tumour has grown into the bladder and surrounding tissues
  • N describes whether the cancer has spread to the lymph nodes
  • M describes whether the cancer has spread to other parts of the body. This is called secondary or metastatic cancer.

Doctors may also use the terms invasive, locally advanced or advanced to describe the cancer. Locally invasive means the cancer is in the muscle or fat layer. Locally advanced means the cancer has spread outside the bladder. Advanced means the cancer has spread to other parts of the body.

If you have invasive and advanced bladder cancer, the grade will not affect your treatment.

Staging

The stage of a cancer describes how far it has grown from where it started and whether it has spread. Test results provide a lot of information, but the exact stage of the cancer won’t be known until after surgery to remove it. Knowing the stage of the cancer helps your doctor decide on the best treatment for you.

Doctors often use the TNM system to stage bladder cancer. This system combines the following to give the overall stage of the cancer:

  • T is how far the tumour has grown into the bladder and how far it has spread into the surrounding tissues
  • N is whether the cancer has spread to nearby lymph nodes
  • M is whether the cancer has spread to other parts of the body. This is called secondary or metastatic cancer.

Tumour

Invasive and advanced bladder cancer is staged as T2–T4. Your doctor or specialist nurse can tell you more about your stage of bladder cancer:

  • T2 – the cancer has grown into the muscle of the bladder wall
  • T3 – the cancer has grown through the muscle of the bladder and into the fat layer surrounding it
  • T4 – the cancer has spread into the prostate (in men), or the womb or vagina (in women). It is also when the cancer has spread into the wall of the tummy (abdomen) or pelvis.

The bladder and bladder wall
The bladder and bladder wall

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Nodes

  • N0 – there is no cancer in the lymph nodes
  • N1 – the cancer is in one of the lymph nodes near the bladder in the pelvis
  • N2 – the cancer is in more than one lymph node in the pelvis
  • N3 – there is cancer in one or more of the lymph nodes further from the bladder but within the tummy.

Metastases

  • M0 – the cancer has not spread to other parts of the body
  • M1 – the cancer has spread to other parts of the body, such as the bones, the lungs, the liver, or lymph nodes outside the tummy.

Doctors may use other terms to describe bladder cancer:

  • Invasive – the cancer is in the muscle layer of the bladder or has spread into the fat layer. But it has not spread outside the bladder.
  • Locally advanced – the cancer has spread outside the bladder into the nearby tissues, prostate, vagina, ovaries, womb or back passage.
  • Advanced – the cancer has spread to other parts of the body, such as the lymph nodes, liver, lungs and bones.


Grading

Grading is how the cancer cells look when they are examined under a microscope. If you have invasive and advanced bladder cancer, grading will not affect what treatment you will have. Your doctor can tell you more about grading.

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