Stages of Bladder Cancer

Bladder cancer staging is used to help your doctor understand the extent of your cancer, including if cancer cells have spread beyond the bladder and how far, and how best to treat it. Staging is usually the next step after you have been diagnosed with bladder cancer.

Bladder cancer staging is one of the most important parts of developing a treatment plan. This article will review the bladder cancer stages and how they are determined. It will also give an overview of the staging system. 

Understanding Bladder Cancer Staging

The stages of bladder cancer range from 0 to 4. Some of the stages also include different categories within the stage itself.

To determine the stage of your cancer, your medical team will determine how far your cancer has grown into the wall of the bladder, if it has grown into nearby organs, and if it has spread to lymph nodes and distant organs. The higher the stage of bladder cancer, the more advanced and widespread the cancer is.

To better understand bladder cancer stages, it’s helpful to know more about the bladder itself. The bladder has four layers. The innermost layer is called the urothelium, or transitional epithelium. This is where almost all bladder cancers start. The next layer contains connective tissue, blood vessels, and nerves. Next is a layer of muscle, and finally, the outer layer is made up of fatty connective tissue. 

To determine the stage of bladder cancer, your medical team will order several tests, including:

• Bladder biopsy: This is a procedure in which small pieces of tissue are removed from the bladder and tested under a microscope.
• Lymph node biopsy: This is the removal of lymph node tissue for examination under a microscope.
• Computed tomography (CT) scan: A CT scan of the kidney, ureters, and bladder is called a CT urogram. It can provide detailed information about the size, shape, and position of tumors in the urinary tract, including the bladder.
• Magnetic resonance imaging (MRI): MRI also shows detailed images of soft tissues in the body. It's very useful in locating cancer that has spread outside of the bladder into nearby tissues or lymph nodes. A special MRI of the kidneys, ureters, and bladder called an MRI urogram can be used to look at the upper part of the urinary system.
• X-ray: An intravenous pyelogram (IVP), also called an intravenous urogram (IVU), is an X-ray of the entire urinary system taken after injecting a special dye into a vein.  

Bladder Cancer Doctor Discussion Guide

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TNM System

The staging system most commonly used to describe stages of bladder cancer is the TNM system. TNM stands for:

• T for tumor: How far the primary tumor has grown through the bladder wall or to nearby tissues
• N for nodes: Any spread of cancer cells to the lymph nodes near the bladder
• M for metastasis: Any spread (metastasis) of the cancer to distant sites in the body, such as the lungs or liver

Stage 0

Stage 0, also known as carcinoma in situ, describes a precancerous stage when there is no cancer present. Abnormal cells are found in the inner lining of the bladder. These cells are at risk of becoming cancerous and then spreading. There are no symptoms associated with stage 0 bladder cancer. 

Stage 1

In stage 1 bladder cancer, cancerous cells are found in the urothelium and the next connective tissue layer. The earliest sign of bladder cancer is usually blood in the urine. Your urine may appear light pink or red, depending on how much bleeding is present. Bladder cancer is often caught early because of blood in the urine in the early stages. 

Stage 2

In stage 2 bladder cancer, cancerous cells have spread beyond the first two layers of the bladder and are now present in the muscle tissue layer of the bladder. In addition to blood in the urine, you may notice changes in bladder habits like urgency or an inability to empty your bladder. It’s also possible to experience pain or burning with urination. 

Stage 3

In stage 3 bladder cancer, cancerous cells have spread beyond the bladder into surrounding areas of the body. Once bladder cancer has reached stage 3, you may notice more severe symptoms like being unable to urinate or having low back pain. 

Stage 3 is split into two categories. In stage 3A, cancerous cells have spread from the bladder into the layer of fat surrounding the bladder. They may also have spread to nearby reproductive organs like the prostate, uterus, or vagina. At this stage, it has spread to one lymph node in the pelvis area. 

In stage 3B, cancerous cells have spread from the bladder to at least two lymph nodes in the pelvis area or along the iliac arteries, which provide blood to the legs, pelvis, reproductive organs, and other organs in the pelvic area. 

Stage 4

Stage 4 bladder cancer is the final stage and occurs when cancer has metastasized to distant areas of the body. Signs of stage 4 bladder cancer include loss of appetite, weight loss, fatigue, weakness, swelling, and bone pain. 

In stage 4A bladder cancer, cancerous cells have spread to the wall of the abdomen or pelvis or to lymph nodes that are above the common iliac arteries. These are major arteries located in the pelvis.

In stage 4B bladder cancer, cancerous cells have spread to distant areas of the body, such as the lungs, bones, or liver. 

Summary

The stages of bladder cancer describe how advanced and widespread the disease is in the body. In bladder cancer, staging determines if cancerous cells have spread beyond the bladder. There are four stages of bladder cancer. Staging is an important tool for choosing the most effective treatment plan. 

A Word From Verywell

Learning that you have bladder cancer is a frightening and overwhelming experience. Fortunately, most cases of bladder cancer are caught early because of the noticeable symptoms present in the early stages. If you are experiencing blood in the urine or painful urination, see your doctor right away.