Stages of bladder cancer

Staging systems

There are different staging systems. The most common way to stage bladder cancer is with the TNM staging system. Doctors may also use the number system, but this is less common for bladder cancer.

The tests and ​scans​ you had to diagnose bladder cancer give some information about the stage.

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

TNM stands for tumour, node and metastasis.

Tumour (T)

Tumour describes the size of the cancer. There are several T stages:

CIS or Tis

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

Ta 

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

T1

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

T2

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

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

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)​

Nodes (N)

Node 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.

N (node) is divided into 4 stages - N0 to N3:

• N0 means there are no cancer cells in the 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 nodes just outside the pelvis

Metastasis (M)

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

M (metastasis) is divided into 2 main stages - M0 and M1.

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

M1 means the cancer has spread to other parts of the body. It is split into M1a and M1b:

• M1a means the cancer has spread to the lymph nodes outside the pelvis 

• M1b means the cancer has spread to other parts of the body, such as 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 as 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 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 abdomen or 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 also 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.

Read more about non muscle invasive bladder cancer and treatment

Muscle invasive bladder cancer

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

Read about muscle invasive bladder cancer

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.

Read about metastatic bladder cancer