Stages of bladder cancer

The stage of a cancer means how big the cancer is and whether it has spread. Knowing the stage helps your doctor decide which treatment you need.

The tests you have to diagnose your bladder cancer help your doctor find out the stage.

The TNM staging system is the most common way that doctors stage bladder cancer. TNM stands for Tumour, Node, Metastasis.

Doctors may also use a number staging system, but this is less common for bladder cancer.

Your doctor may use other terms to describe your bladder cancer stage. These include:

  • non muscle invasive bladder cancer
  • invasive or muscle invasive bladder cancer
  • metastatic bladder cancer

TNM staging

This is the most common way that doctors stage bladder cancer. TNM stands for Tumour, Node, Metastasis.

Tumour (T)

Tumour describes the size of the tumour.

There are several T stages:

CIS or Tis means very early, high grade cancer cells are only in the innermost layer of the bladder lining.

Ta means the cancer is just in the innermost layer of the bladder lining.

T1 means the cancer has started to grow into the connective tissue beneath the bladder lining.

T2 means the cancer has grown through the connective tissue into the muscle​. It is divided into T2a and T2b.

  • T2a means the cancer has grown into the superficial muscle

  • T2b means the cancer has grown into the deeper muscle

T3 means the cancer has grown through the muscle into the fat layer. It is split into T3a and T3b.

  • T3a means the cancer in the fat layer can only be seen under a microscope (microscopic invasion)

  • T3b means the cancer in the fat layer can be seen on tests, or felt by your doctor during an examination under anaesthetic (macroscopic invasion)

T4 means the cancer has spread outside the bladder​. It is split into T4a and T4b.

  • T4a means the cancer has spread to the prostate, womb (uterus) or vagina

  • T4b means the cancer has spread to the wall of the pelvis or tummy (abdomen)

Diagram showing the T stages of bladder cancer

Node (N)

Node in TNM means your lymph nodes. These are a network of glands throughout the body, for example in your armpits, neck and groin. They drain away waste fluid, waste products and damaged cells, and contain cells that fight infection.

Cancer cells can enter the lymphatic system and travel around the body.

There are 4 lymph node (N) stages in bladder cancer - N0 to N3:

  • N0 means there are no cancer cells in any lymph nodes
  • N1 means there are cancer cells in one lymph node in the pelvis (between your hip bones)
  • N2 means there are cancer cells in more than one lymph node in the pelvis
  • N3 means there are cancer cells in one or more lymph node just outside the pelvis

Your doctor may call your cancer 'locally advanced bladder cancer'  if it has spread to nearby lymph nodes (stages N1-3).  

Diagram showing stage N1 bladder cancer

Metastasis (M)

Metastasis describes whether the cancer has spread to a different part of the body.

There are 2 M stages:

  • M0 means your cancer has not spread to other parts of the body
  • M1 means your cancer has spread to other parts of the body 

M1 can be divided into M1a and M1b:

  • M1a means your cancer has spread to the lymph nodes outside the pelvis
  • M1b means your cancer has spread to other parts of the body like the bones, lungs and liver

Cancer that has spread to other areas of the body, such as the lungs, is called advanced or metastatic bladder cancer.

Number stages

There is another staging system for bladder cancer which is not used often. It has 5 main stages, numbered from stage 0 to stage 4. Stage 0 is the earliest cancer and stage 4 is the most advanced.

Stage 0

The cancer is just in the inner layer of the bladder lining (stage 0a) OR there are very early, high grade cancer cells only in the inner layer of the bladder lining (stage 0is).

Stage 1

The cancer has started to grow into the connective tissue beneath the bladder lining.

Stage 2

The cancer has grown through the connective tissue layer into the muscle of the bladder wall.

Stage 3

The cancer has grown through the muscle into the fat layer and may have spread to the prostate, womb or vagina. It might also have spread to nearby lymph nodes. 

Stage 4

The cancer has spread to the wall of the tummy (abdomen) or between the hips (pelvis), to distant lymph nodes or to other parts of the body such as the bones, lungs or liver.

Other ways of describing bladder cancer stages

Your doctor might use the following terms to describe your bladder cancer stage:

Non muscle invasive bladder cancer

This means the cancer cells are only in the inner lining of the bladder. They have not grown through the inner lining and into the deeper muscle layer of the bladder. It is early in its development.

Muscle invasive bladder cancer

This means the cancer has spread into or through the muscle layer of the bladder.

Metastatic bladder cancer

Metastatic bladder cancer means the cancer has spread from the bladder to other parts of the body. It is also called advanced cancer. Bladder cancer might spread to lymph nodes in other parts of the body or to the bones, liver or lungs.

  • American Joint Committee on Cancer (AJCC) manual (8th edition)
    S Edge and others
    Springer, 2017

  • Bladder cancer: diagnosis and management of bladder cancer
    National Institute of Health and Clinical Excellence, 2015

  • Bladder cancer
    A M Kamat and others
    The Lancet, 2016. Volume 388, Pages 276 -2810

  • Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.
    T Powles and others
    Annals of oncology, 2022 Volume 33, Issue 3, Page 244 - 258

  • European Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS)
    M Babjuk and others
    European Association of Urology, 2022

  • European Guidelines on Muscle-invasive and Metastatic Bladder Cancer 
    J A Witjes and others
    European Association of Urology, 2022

Last reviewed: 
22 Sep 2022
Next review due: 
22 Sep 2025

Related links