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Bladder Cancer Stages and Grades

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: September 2017

When a patient is diagnosed with bladder cancer, healthcare providers use a process called staging to describe the patient’s specific type of cancer. Staging provides detailed information about the location of the cancer and whether it has metastasized and spread to other parts of the body.1,2

Why is bladder cancer staging important?

Staging is an important process because it helps to inform healthcare providers about the best possible treatment options for a patient’s bladder cancer. It also provides a way for healthcare providers to predict how well a patient will respond to treatment.

Types of bladder cancer staging

There are two types of bladder cancer staging: clinical staging and pathologic staging. Clinical staging is done by healthcare providers based on the physical examination of the patient as well as the results of diagnostic tests such as cystoscopy, biopsy, and imaging tests. The process of clinical staging is not always as accurate as pathologic staging, which can be done if surgery is used to treat the cancer.

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What is the TNM staging system?

The TNM staging system for bladder cancer is used to describe a patient’s cancer in a standardized way that can be understood by all the healthcare providers in a patient’s cancer care team.1,2 The TNM system includes information about a patient’s bladder cancer in three categories:

  • Tumor (T)
  • Node (N)
  • Metastasis (M)

A patient’s bladder cancer is described using numbers and/or letters after T, N, and M to provide more detail. If the numbers are higher, it indicates that the bladder cancer is more advanced.

Tumor (T)

The Tumor (T) category describes the size and location of the primary bladder cancer tumor using a letter and/or a number from 0 to 4. The letter m (for multiple) may be added to the T category if there is more than one tumor. The T staging category includes: TX, T0, Ta, Tis, T1, T2, T2a, T2b, T3, T3a, T3b, T4, T4a, and T4b.

Node (N)

The Node (N) category describes whether or not the bladder cancer has spread to lymph nodes near the bladder. If it has, then the N category describes exactly which lymph nodes the cancer has affected. The N staging category includes: NX, N0, N1, N2, and N3.

Metastasis (M)

The Metastasis (M) category describes whether the cancer has spread to organs and/or lymph nodes in other parts of the body that are more distant from the bladder. The category M1 means that the cancer has spread to distant parts of the body and the category M0 means that the cancer has not spread to distant parts of the body.

5 stages of bladder cancer

A patient’s overall bladder cancer stage is determined by information combined from the three T, N, and M staging categories.1,2 There are five different overall stages of bladder cancer. Stage 0 is the earliest stage and stage IV is the most advanced stage.

Stage 0 bladder cancer includes the following combined TNM stages:

  • [Ta, N0, M0]
  • [Tis, N0, M0]

Stage I bladder cancer includes the following combined TNM stage:

  • [T1, N0, M0]

Stage II bladder cancer includes the following combined TNM stages:

  • [T2a, N0, M0]
  • [T2b, N0, M0]

Stage III bladder cancer includes the following combined TNM stages:

  • [T3a, N0, M0]
  • [T3b, N0, M0]
  • [T4a, N0, M0]

Stage IV bladder cancer includes the following combined TNM stages:

  • [T4b, N0, M0]
  • [Any T, N1/N2/N3, M0]
  • [Any T, any N, M1]

Low grade vs. high grade bladder cancer

In addition to staging, bladder cancer is also described using its grade (G).2,3 To understand the cancer’s grade, healthcare providers compare healthy cells to cancer cells under a microscope. Low-grade cancer cells are ones that appear more like healthy tissue, while high-grade cancer cells look very different than healthy cells.

Bladder cancer recurrence

Bladder cancer that is low grade tends to grow again (recur) in the bladder after it is treated, but it usually does not spread into the muscle of the bladder or metastasize to other parts of the body. High-grade bladder cancer also tends to recur in the bladder, but it is also more likely to grow into the muscle of the bladder and/or spread to other parts of the body. High-grade bladder cancer accounts for nearly all bladder cancer deaths.