Bladder Cancer (Cancer of the Urinary Bladder)

  • Medical Author: Kevin C. Zorn, MD, FRCSC, FACS
  • Medical Author: Gagan Gautam, MD, MCh
  • Medical Author: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideBladder Cancer Symptoms, Stages, Treatments

Bladder Cancer Symptoms, Stages, Treatments

How is bladder cancer staging determined?

Bladder cancer is staged using the tumor node metastases (TNM) system developed by the International Union Against Cancer (UICC) in 1997 and updated and used by the American Joint Committee on Cancer (AJCC). In addition, the American Urologic Association (AUA) has a similar staging system that varies slightly from that used by the AJCC. Both are combined and are listed below. This staging gives your physician a fairly complete picture of the extent of the person's bladder cancer.

The tumor or the T stage is accorded by a pathological examination of the tumor specimen removed surgically. This refers to the depth of penetration of the tumor from the innermost lining to the deeper layers of the bladder. The T stages are as follows:

  • Tx - Primary tumor cannot be evaluated
  • T0 - No primary tumor
  • Ta - Noninvasive papillary carcinoma (tumor limited to the innermost lining or the epithelium)
  • Tis - Carcinoma in situ (flat tumor)
  • T1 - Tumor invades connective tissue under the epithelium (surface layer)
  • T2 - Tumor invades muscle of the bladder
    • T2a - Superficial muscle affected (inner half)
    • T2b - Deep muscle affected (outer half)
  • T3 - Tumor invades perivesical (around the bladder) fatty tissue
    • T3a - Microscopically (visible only on examination under the microscope)
    • T3b - Macroscopically (for example, visible tumor mass on the outer bladder tissue)
  • T4 - Tumor spreads beyond fatty tissue and invades any of the following: prostate, uterus, vagina, pelvic wall, or abdominal wall

The node or the N stage is determined by the presence and extent of involvement of the lymph nodes in the pelvic region of the body near the urinary bladder. The N stages are as follows:

  • Nx - Regional lymph nodes cannot be evaluated
  • N0 - No regional lymph node metastasis
  • N1 - Metastasis in a single lymph node < 2 cm in size
  • N2 - Metastasis in a single lymph node > 2 cm, but < 5 cm in size, or two or more lymph nodes < 5 cm in size
  • N3 - Metastasis in a lymph node > 5 cm in size and/or to lymph nodes along the common iliac artery

The metastases or the M stage signifies the presence or absence of the spread of bladder cancer to other organs of the body.

  • Mx - Distant metastasis cannot be evaluated (This stage is not used by some clinicians.)
  • M0 - No distant metastasis
  • M1 - Distant metastasis

Stage is then assigned:

  • Stage 0a Ta N0 M0
  • Stage 0is  Tis N0 M0
  • Stage 1 T1 N0 M0
  • Stage 2  T2 N0 M0
  • Stage 3  T3 N0M0
  • Stage 4   T4 N0 M0, or any T, N1 or above M0 , or any T, any N, M1

The proper staging of bladder cancer is an essential step which has significant bearings on the management of this condition. The implications of bladder stage are as follows:

  • It helps select proper treatment for the patient. Superficial disease (Ta/T1/Tis) can generally be managed with less aggressive treatment as compared to invasive disease (T2/T3/T4).
  • Invasive tumors have a higher likelihood of spread to lymph nodes and distant organs as compared to superficial tumors.
  • The chances of cure and long-term survival progressively decrease as the bladder cancer stage increases.
  • Staging allows proper classification of patients into groups for research studies and study of newer treatments.
Medically Reviewed by a Doctor on 2/26/2016

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