Staging and grading of bladder cancer

Knowing the stage and grade of the bladder cancer helps your doctors plan the best treatment for you. They get this information from the tests you have.

Staging and grading

Your cancer doctor needs certain information about the cancer to advise you on the best treatment for you. This includes the stage of the bladder cancer and its grade.

They get this information from the tests you have. If you have surgery to remove bladder cancer, they may get information from this too.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. You can:

Call the Macmillan Support Line for free on 0808 808 00 00.
Chat to our specialists online.

What is staging?

Bladder cancer staging describes:

how far it has grown into the bladder
whether it has spread from where it first started.

The most commonly used bladder cancer staging system is the TNM system.

TNM staging for bladder cancer

The TNM staging system uses letters and numbers to describe the bladder cancer.

T stands for tumour

This explains how far the tumour has grown into the bladder, and how far it has spread into the surrounding tissue.
N stands for nodes
This explains whether the tumour has spread to lymph nodes.

N0 means there is no cancer in the lymph nodes.

N1 means the cancer is in 1 of the lymph nodes in the pelvis, near the bladder.

N2 means the cancer is in more than 1 lymph node in the pelvis.

N3 means there is cancer in 1 or more of the lymph nodes further away from the bladder but in the tummy (abdomen).
M stands for metastasis
This is whether the tumour has spread to another part of the body. This is called secondary or metastatic cancer.

M0 means the cancer has not spread to other parts of the body.

M1 means the cancer has spread to other parts of the body, such as the bones, lungs, liver, or lymph nodes outside the tummy.

Your doctor or specialist nurse can tell you more about the stage of the bladder cancer you have.

Tumour staging for non-muscle-invasive bladder cancer

Non-muscle-invasive bladder cancer means the cancer cells are either in the:

inner lining called the urothelium
connective tissue that surrounds the inner lining of the bladder.

Non-muscle-invasive bladder cancer can be staged as carcinoma in situ (CIS), Ta or T1.

Image: Staging non-muscle invasive bladder cancer

Carcinoma in situ (CIS)

This is sometimes described as a flat tumour. The cancer cells are only in the inner layer of the bladder lining (urothelium).

Ta

The tumour is a mushroom-like growth (papillary cancer). It is only in the inner layer of the bladder lining.

T1

The tumour has started to grow into the layer of connective tissue, beneath the bladder lining.

Some people may have both papillary cancer and CIS.

Tumour staging for muscle-invasive and advanced bladder cancer

Muscle-invasive and advanced bladder cancer is staged as T2 to T4.

Image: Staging muscle-invasive and advanced bladder cancer

T2

Tumours have grown into the muscle of the bladder wall.

T3

Tumours have grown through the muscle of the bladder and into the fatty tissue around the bladder.

T4

Tumours have spread to other parts of the body near the bladder or in the pelvis.

Other terms used for bladder cancer stages

Doctors may use other terms to describe the stage of bladder cancer:

Locally advanced

This is when the cancer has spread outside the bladder into nearby tissues, such as the prostate, vagina, ovaries, womb or back passage (rectum). It may also be in lymph nodes near to the bladder.
Advanced

This is when the cancer starts in the bladder and spreads to other parts of the body. For example, the liver, lungs or bones, or lymph nodes further from the bladder.

Bladder cancer grading is about how the cancer cells look under a microscope compared with normal cells. With muscle-invasive or advanced bladder cancer grading does not affect your treatment. With non-muscle-invasive bladder cancer grading is used to help your doctor plan your treatment.

Bladder cancer grades are:

grade 1 – the cancer cells look very similar to normal bladder cells, they are usually slow-growing and are less likely to spread
grade 2 – the cancer cells look less like normal cells and are slightly faster growing
grade 3 – the cancer cells look very different to normal cells and usually grow more quickly.

Your doctor may combine the stage and grade of the tumour when talking about your results. For example, they may say you have a TaG1 tumour. This means it is stage Ta and a grade 1 tumour.

Doctors may also use another bladder cancer grading system:

low-grade – the cancer cells are slow-growing and are less likely to spread
high-grade – the cancer cells grow more quickly and are more likely to spread. Carcinoma in situ (CIS) is always classed as high-grade.

Your doctor may combine the 2 grading systems.

About our information

References

Below is a sample of the sources used in our bladder cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Mottet N, Bellmunt J, Briers E, et al. Non-muscle-invasive bladder cancer (TaT1 and CIS). European Association of Urology (Internet), 2021. Available from uroweb.org/guideline/non-muscle-invasive-bladder-cancer (accessed September 2021).

Witjes JA, Bruins HM, Cathomas R, et al. Muscle-invasive and metastatic bladder cancer. European Association of Urology (Internet), 2021, Available from uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic (accessed September 2021).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.