Overview of bladder cancer staging and grading

When a patient is diagnosed with cancer, the next step is to identify the disease stage. Bladder cancer staging is important because it enables the doctor to plan the best treatment for the patient. Also the ability to cure the disease decreases depending on the cancer stage.

Tests are done to determine the stages of bladder cancer. The stage is based on if the cancer has spread and where and how far the cancer has spread. The following tests are a few the doctor may use.

Cystoscopy is a test to look in the urethra as well as the urinary bladder and for abnormal cells. A cystoscopy is used which is an instrument like a tube that has a light to view the area. It may also have the ability to collect tissue to view under a microscope for cancer.

A CT scan takes a series of pictures looking inside the body. The patient may be asked to ingest a dye to make the organs more clearly seen.

MRI (magnetic resonance imaging) uses a magnet to take pictures of inside the body.

These are only a couple of tests that may be performed to help the doctor determine if cancer has extended inside the body. Once the doctor learns the extent of the disease he uses the tumor node metastases system to stage the bladder cancer.

A T (tumor) grading is based on an examination of the tumor that has been surgically removed. T stages are:

Anatomy of the bladder and illustration of the tumor stagingTx means a tumor is unable to be evaluated.

T0 indicates no primary tumor.

Ta means a tumor is found only in the innermost lining.

Tis is a flat tumor.

T1 means a tumor that has invaded the connective tissue.

T2 means a tumor that has invaded the bladder muscle.

T3 means a tumor that has invaded the fatty tissue around the bladder.

T4 means a tumor that had invaded areas outside of the bladder like the prostate, vagina, or abdominal wall.

A N (node) grading is based on if the lymph nodes in the region around the bladder have been affected by the cancer. N stages are:

Nx means the lymph nodes are unable to be evaluated.

N0 means the cancer has not spread to the lymph nodes.

N1 means one lymph node is affected less than 2cm in size.

N2 means one lymph node is affected between 2cm and 5cm in size or multiple lymph nodes are affected.

N3 means the size is more than 5cm in a lymph node.

There is also a third letter to evaluate the staging of the cancer: M

M0 refers to a cancer that has not propagated far.

M1 refers to a cancer that has propagated far to other organs in the body.

Once the above grades have been evaluated, they are put together to rate the actual stage of the cancer. Theses stages are rated with 0 as well as the Roman numerals from I up to IV (1 up to 4).

Stage 0 is non-invasive cancer.

Stage I means the cancer is found in the connective tissue but has not reached the layer of muscle.

Stage II means the cancer is found in the muscle layer.

Stage III means the cancer has spread through the bladder and to other areas like the vagina or prostate.

Stage IV means the cancer has spread to lymph nodes or to further areas of the body.