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Early bladder cancer stages and grading

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This page tells you about the stages and grading of early bladder cancer. You can go straight to information about

 

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Early bladder cancer

Early bladder cancer is also called superficial bladder cancer or non muscle invasive bladder cancer. It means that the cancer cells are only in the inner lining of the bladder and have not spread into the muscle layer of the bladder.

What staging is

Cancers are divided into stages, depending on how far they have grown. The staging system normally used in bladder cancer is called TNM, which stands for tumour, node, metastasis. TNM staging takes into account how deeply the tumour has grown into the bladder, whether there is cancer in the nearby lymph nodes, and whether cancer has spread to other parts of the body (metastasis).

The T stages of bladder cancer

Cancer that is only in the innermost lining of the bladder is classed as carcinoma in situ (CIS or Tis), or Ta. Cancer that has grown further into the bladder has a T number from 1 to 4.  Ta, T1 and CIS tumours are classed as non muscle invasive (superficial) or early bladder cancer.

Grade

You may hear doctors talk about the grade of your cancer. This means how well developed the cells look under the microscope. In low grade cancers, the cells look very like normal cells and tend to grow slowly and stay within the bladder lining. High grade cancers tend to grow more quickly and are more likely to come back after treatment (recur) or to spread into the muscle layer of the bladder (progress).

Risk groups

Doctors divide early bladder cancer into 3 risk groups. These risk groups describe how likely it is that your cancer will spread further or come back after treatment. The 3 risk groups are low risk, intermediate (medium) risk, and high risk.

CR PDF Icon You can view and print the quick guides for treating early bladder cancer

 

 

What early bladder cancer is

Early bladder cancer is also called superficial bladder cancer or non muscle invasive bladder cancer. It means that the cancer cells are only in the inner lining of the bladder. This is different to muscle invasive bladder cancer, where the cancer has spread into the muscle layer of the bladder.

 

What staging is

The stage of a cancer tells the doctor how big the cancer is and whether it has spread. The tests and scans you have when diagnosing your cancer give some information about the stage. It is important because treatment is often decided according to the stage of a cancer.

There are different ways of staging cancers. The most common is the TNM system and is used for all cancers. TNM stands for tumour, node, metastasis. So this staging system takes into account

  • How deeply the tumour has grown into the bladder (T)
  • Whether there is cancer in the lymph nodes (N)
  • Whether the cancer has spread to any other part of the body (M)

If the cancer has spread it is called metastasis or metastatic bladder cancer.

Another way of staging cancers is number staging. This is not used much for bladder cancer. There are usually 5 main stages of bladder cancer. Stage 0 is the earliest cancer and stage 4 the most advanced. With bladder cancer, it is more usual to refer to non-muscle invasive (early) bladder cancer, invasive bladder cancer and advanced bladder cancer. Early bladder cancer is also called superficial bladder cancer.

 

What grade is

Your doctor may talk to you about the grade of your cancer. This means how well developed the cells look under the microscope.

  • Grade 1 (G1) cancers have cells that look very like normal cells. They are called low grade or well differentiated. They tend to grow slowly and to stay in the lining of the bladder
  • Grade 2 (G2) cancers have cells that look more abnormal. They are called moderately differentiated and are more likely to spread into the muscle of the bladder (progress) or to come back after treatment than G1 cancers
  • Grade 3 (G3) cancers have cells that look very abnormal. They are called high grade or poorly differentiated. They grow more quickly, are more likely to come back after treatment, and are more likely to spread into the bladder muscle (progress)

Another grading system describes bladder cancer as either ‘low grade’ or ‘high grade'. Grade 1 is low grade and Grade 3 is high grade. Grade 2 can be split into either low or high grade.

If you have early bladder cancer, grade is one thing that your doctor may take into account when deciding your treatment. If the cells are high grade, you are more likely to need further treatment to stop the cancer coming back after it has been removed. Carcinoma in situ tumours of the bladder are high grade.

In 2004 the World Health Organisation developed a new grading system for early bladder cancer, which is increasingly being used. This system divides bladder cancers into the following groups

  • Urothelial papilloma – non cancerous (benign) tumour
  • Papillary urothelial neoplasm of low malignant potential (PUNLMP) – very slow growing and unlikely to spread
  • Low grade papillary urothelial carcinoma – slow growing and unlikely to spread
  • High grade papillary urothelial carcinoma – more quickly growing and more likely to spread
 

The stages of early bladder cancer

Early bladder cancer is also called superficial bladder cancer or non muscle invasive bladder cancer. Doctors diagnose it by looking at how far the cancer cells have grown into the bladder (the T stage).

Early bladder cancer is staged as carcinoma in situ (CIS), Ta or T1.

  • CIS (carcinoma in situ, also called Tis) means that very early, high grade, cancer cells are only in the innermost layer of the bladder lining
  • Ta – the cancer is just in the innermost layer of the bladder lining
  • T1 – the cancer has started to grow into the connective tissue beneath the bladder lining

Diagram showing early stage bladder cancer

Early bladder cancer has not spread to the lymph nodes (N0) and has not spread to another body organ (M0).

CIS (also called Tis) in the TNM staging for bladder cancer stands for carcinoma in situ. It is a high grade non invasive cancer of the flat transitional cells. These cells make up all the moist tissues that line the body organs. It can be in more than one place in the bladder lining and can look like areas of moss under the microscope.

Ta and T1 tumours often look like small mushrooms growing out of the bladder wall.

 

Risk groups for early bladder cancer

Doctors divide early bladder cancer into 3 risk groups. These risk groups describe how likely it is that your cancer will spread further or come back after treatment. Your risk group depends on

  • The T stage
  • The grade
  • The size of tumour
  • How many tumours there are
  • The type of bladder tumour
  • Whether you have had treatment in the last year for early bladder cancer

The 3 risk groups are

  • Low risk non muscle invasive bladder cancer
  • Intermediate (medium) risk non muscle invasive bladder cancer
  • High risk non muscle invasive bladder cancer

Your doctor should tell you whether your cancer is low risk, intermediate (medium) risk or high risk. This is important as they use this risk group information to help them decide which tests and treatment are best for you.

These are all cancers that have been found very early in their development. The cancer cells are only in the lining, the innermost layer, of the bladder. In some people, these cancer cells cause no more trouble after your specialist has removed them and given chemotherapy treatment into the bladder. Higher risk tumours or CIS are more likely to come back after surgery and may need further treatment.

You can read our detailed information about treatment for early bladder cancer.

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Updated: 22 July 2015