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Bladder Cancer: Stages

What does stage of a cancer mean?

The stage of a cancer is how much cancer there is and how far it has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. Scans can also show if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage is one of the most important things to know when deciding how to treat the cancer.

The place where cancer starts is called the primary site. Bladder cancer can spread from the primary site (in the bladder) to other parts of your body. Cancer that has spread is called metastatic cancer. When a cancer spreads, it’s said to have metastasized.

The TNM system for bladder cancer

The most commonly used system to stage bladder cancer is the TNM system from the American Joint Committee on Cancer. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

Start here to begin understanding of bladder cancer stages. The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

  • T tells how far the main (primary) tumor has spread into the lining of your bladder and nearby tissue.

  • N tells if the lymph nodes near the primary tumor have cancer in them.

  • M tells if the cancer has spread ( metastasized) to distant organs in the body, like the liver, lungs, or bones.

Numbers or letters after T, N, and M provide more details about each of these factors. There are also two other values that can be assigned:

  • X means the provider does not have enough information to tell the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX). This value is often used before surgery.

  • 0 means no sign of cancer, such as no sign of cancer in the lymph nodes (N0).

What are the stage groupings of bladder cancer?

The T, N, and M values from the TNM system are used to put these cancers into stage groupings. These groupings give an overall description of your cancer. A stage grouping is listed as a Roman numeral and can have a value of I (1), II (2), III (3), or IV (4). The higher the number, the more advanced the cancer is.

These are the stage groupings of bladder cancer and what they mean:

Stage 0. The cancer is only in the bladder and is one of these:

  • Stage 0a. The cancer cells are found only on the surface of the inner lining of the bladder. The tumor is growing toward the inside, hollow center of the bladder. It's not growing into the bladder wall. This stage is also called noninvasive papillary carcinoma.

  • Stage 0is. The cancer is only on the inner surface lining the bladder. It's flat and not growing toward the center of the bladder. It's not growing into the bladder wall. It may also be called flat carcinoma in situ or noninvasive carcinoma.

Stage I. The cancer has grown deeper into the layer of connective tissue under inner lining of the bladder. But it hasn't spread into the bladder muscle, the fatty tissue around the bladder, lymph nodes, or other parts of the body.

Stage II. The cancer has spread deeper into the muscle layers of the wall of the bladder. It hasn't spread through them to the fatty tissue around the bladder. It has not spread to lymph nodes or organs in other parts of the body.

Stage III. This stage is divided into 2 groups:

  • Stage IIIA. This stage can be either of these:

    • The cancer has grown through the muscle layers of the bladder and into the fatty tissue around the bladder. In men, cancer cells may have spread to the prostate gland or seminal vesicles. In women, it may have spread to the uterus or vagina. The cancer has not spread to lymph nodes or organs in other parts of the body.

    • The cancer has grown into the inner layers of the bladder wall, or into the muscle layers of the bladder wall, or into the fatty tissue around the bladder. It may or may not have spread into the prostate or seminal vesicles (in men) or the uterus or vagina (in women). It has spread to one nearby lymph node. It has not spread to the pelvic or belly (abdominal) wall or to organs in other parts of the body.

  • Stage IIIB. The cancer has grown into the inner layers of the bladder wall, or into the muscle layers of the bladder wall, or into the fatty tissue around the bladder. It may have spread into the prostate or seminal vesicles (in men) or the uterus or vagina (in women). It has spread to two or more nearby lymph nodes or to lymph nodes along the iliac arteries. It has not spread to the pelvic or abdominal wall or to organs in other parts of the body.

Stage IV. This stage is divided into two groups:

  • Stage IVA. This stage can be either of these:

    • The cancer has grown through the bladder wall and into the wall of the belly (abdomen) or to the wall of the pelvis. It may have spread to nearby lymph nodes. It has not spread to organs in other parts of the body.

    • The cancer may have grown through the bladder wall and spread to nearby organs or nearby lymph nodes. It has spread to distant lymph nodes.

  • Stage IVB. The cancer may have grown through the bladder wall and spread to nearby organs or nearby lymph nodes. It has spread to one or more organs in other parts of the body, like the lungs, bones, or liver.

Talking with your healthcare provider

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand. Ask any questions and talk about your concerns.

Medical Reviewers:

  • Jessica Gotwals RN BSN MPH
  • Melinda Murray Ratini DO
  • Todd Gersten MD
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