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Early (non muscle invasive) bladder cancer staging

Early bladder cancer 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.

Early bladder cancer is also called superficial bladder cancer, or non muscle invasive bladder cancer.

The stages of early bladder cancer

Doctors diagnose early bladder cancer by looking at how far tumours have grown into the bladder. This is called the T stage. There are 3 T stages of early bladder cancer - Tis, Ta and T1.

Carcinoma in situ (CIS or Tis)

Carcinoma in situ (also called CIS or Tis) means very early, high grade cancer cells that are only in the innermost layer of the bladder lining.

It is a non invasive cancer of the flat urothelial or transitional cells. These cells make up all the moist tissues that line your body organs.

They can grow in more than one place in the bladder lining and look like flat velvety patches through a microscope.

Ta and T1

The cancer is only in the innermost layer of the bladder lining (Ta) OR has started to grow into the connective tissue beneath the bladder lining (T1).

These tumours often look like small mushrooms growing out of the bladder wall.

Diagram showing early stage bladder cancer

Doctors also look at whether the cancer has spread to:

  • any lymph nodes (this is called the N stage)
  • other parts of the body (distant metastasis) like the bones, lungs or liver (this is called the M stage)

Early bladder cancer has not spread to the lymph nodes (N0) or to distant parts of the body (M0).

Risk groups for early bladder cancer

Doctors put early bladder cancer into 3 risk groups. These 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
  • high risk

Your doctor tells you whether your cancer is low risk, intermediate (medium) risk or high risk. Knowing your risk group helps them decide which tests and treatment are best for you.

Your risk group depends on:​​

  • the size of your tumour (T stage)
  • what the cells look like under a microscope (grade)
  • how many tumours there are
  • the type of bladder tumour
  • whether you have had treatment in the last year for early bladder cancer

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • your risk group (low, intermediate or high)
  • where the cancer is
  • other health conditions

Treatment may include:

  • surgery
  • chemotherapy into your bladder
  • a vaccine called BCG into your bladder
Last reviewed: 
22 Oct 2018
  • 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

  • BMJ Best Practice. Bladder Cancer
    D Lamm and others
    BMJ Publishing Group, (Updated June 2018)

  • European Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS)
    M Babjuk and others
    European Association of Urology, 2017

  • Bladder cancer: Overview and disease management. Part 1: non-muscle-invasive bladder cancer
    B Anderson
    British Journal of Nursing, 2018. (Urology Supplement) Volume 27, Issue 9, Pages 27-37

  • Management of carcinoma in situ of the bladder: best practice and recent developments
    D H Tang and S S Chang
    Therapeutic Advances in Urology, 2015. Volume 7, Issue 6, Pages 351 – 364

Information and help

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