Staging and grading

When bladder cancer is diagnosed, it is important to know the stage and grade of the cancer. This helps your doctors decide on the best treatment for you. 

Staging

The stage of a cancer describes its size, position and whether it has spread from where it started. 

Test results provide some information about the stage of the cancer. But your doctor won’t know the exact stage until after the cancer has been removed with surgery.

Doctors often use the TNM system to stage bladder cancer:

  • T is how far the tumour has grown into the bladder.
  • N is whether the cancer has spread to the nearby lymph nodes and which nodes are involved.
  • M is whether the cancer has spread to another part of the body. This is called secondary or metastatic cancer.

N and M are not used in non-invasive bladder cancer. This is because they are used to describe cancers that have spread.

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. The cancer cells are only in the very inner layer of the bladder lining.
  • Ta – the cancer is a mushroom-like growth (papillary cancer) that is 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.

The stages of non-invasive bladder cancer
The stages of non-invasive bladder cancer

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Invasive and advanced bladder cancer

In stage T2, T3 and T4 tumours, the cancer has grown into the muscle layer of the bladder (invasive bladder cancer) and may have spread further.

You can read more about these stages in our information about invasive and advanced bladder cancer.

Grading

Grading is how the cancer cells look under the microscope compared with normal cells. The grade helps your doctor to decide if you need further treatment after surgery. You are likely to need further treatment if the cancer is grade 2 or 3.

  • Grade 1 – the cancer cells look a lot like normal bladder cells. They are usually slow-growing and are less likely to spread.
  • Grade 2 – the cancer cells look more abnormal and grow slightly more quickly than grade 1 cancer.
  • Grade 3 – the cancer cells look very abnormal. They are more likely to grow more quickly.

Your doctor may combine the stage and grade of the tumour when talking about your results. For example, TaG1 is a stage Ta tumour which is grade 1.

Doctors may also use another grading system for bladder cancer:

  • low grade – the cancer cells are slow-growing and less likely to spread
  • high grade – the cancer cells grow more quickly and are more likely to spread.

Your doctor may combine the two grading systems together.

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

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Treatment overview

Surgery is the main treatment for non-invasive bladder cancer. You may also have chemotherapy or a BCG treatment.