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Bladder cancer stages

The American Joint Committee on Cancer (AJCC) developed the TNM system to evaluate three primary factors when it comes to treating cancer:

T (tumor): This describes the size of the original tumor.

N (node): This indicates whether the cancer is present in the lymph nodes.

M (metastasis): This refers to whether cancer has spread to other parts of the body.

A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed.

Once the T, N and M scores have been assigned, an overall bladder cancer stage is assigned.

T categories for bladder cancer:

These measurements refer to the primary tumor.

  • TX means the primary tumor cannot be assessed or information is not known.
  • TO means no evidence of primary tumor.
  • Ta indicates noninvasive papillary carcinoma.
  • Tis indicatesnoninvasive flat carcinoma, also called flat carcinoma in situ. This means that the disease is still localized, or contained within the urothelium layer of the bladder wall. Cancer cells have not invaded the deeper layers of bladder wall tissue.
  • T1 means the tumor has grown from the layer of cells lining the bladder into the connective tissue below. It has not grown into the muscle layer of the bladder.
  • T2 means the tumor has grown into the muscle layer. T2 has two sub-categories:
    • T2a means the tumor is in the inner half of the muscle layer.
    • T2b means the tumor is in the outer half of the muscle layer.
  • T3 means the tumor has grown through the muscle layer and into the surrounding fatty tissue. T3 has two sub-categories:
    • T3a means this spread into the fatty tissue can only be seen with a microscope.
    • T3b means this spread into the fatty tissue is large enough to be seen on imaging test or to be seen/felt by the surgeon.
  • T4 means the tumor has spread into nearby organs or structures. It may be growing in the stroma (main tissue) of the prostate, the seminal vesicles, uterus, vagina, pelvic wall or abdominal wall.

N categories for bladder cancer:

  • NX means nearby lymph nodes cannot be assessed or information is not known.
  • N0 means the cancer has not spread to any nearby lymph nodes.
  • N1 means the cancer has spread to one lymph node in the true pelvis.
  • N2 means the cancer has spread to two or more lymph nodes in the true pelvis.
  • N3 means the cancer has spread to lymph nodes that lie along the common iliac artery.

M categories for bladder cavity and oropharyngeal cancers:

  • M0: no distant spread
  • M1: the cancer has spread to distant sites outside the bladder region (for example, the lungs, liver or bones)

Once the categories have been assigned, the cancer is staged in one of the following ways:

Stage 0 has two subcategories:

  • Stage 0a: Bladder cancer is noninvasive papillary carcinoma. Cancer has grown toward the hollow center of the bladder but not into the connective tissue or muscle layer. There are no malignant cells in the lymph nodes or distant sites.
  • Stage 0is: Flat, noninvasive carcinoma or carcinoma in situ. In this stage of bladder cancer, the tumor is growing only in the inner lining layer of the bladder. It has not grown toward the hollow part of the bladder and has not invaded the connective tissue or muscle of the bladder wall. No malignant cells have been found in the lymph nodes or distant sites.

Stage I (stage 1 bladder cancer): The cancer has grown into the layer of connective tissue beneath the lining layer of the bladder wall. The disease has not spread to lymph nodes or distant sites.

Stage II (stage 2 bladder cancer): The cancer has grown into the muscle layer of the bladder wall. It has not grown through the muscle layer into the fatty tissue surrounding the bladder. In this bladder cancer stage, the disease has not spread to lymph nodes or distant sites.

Stage III (stage 3 bladder cancer): The cancer has grown through the bladder wall into the surrounding fatty tissue. It may also be in the prostate, uterus or vagina. It is not present in the pelvic or abdominal wall and has not spread to lymph nodes or distant sites.

Stage IV (stage 4 bladder cancer): In stage IV bladder cancer, one of the following applies:

  • Cancer has grown through the bladder wall and into the pelvic or abdominal wall, but it has not spread to lymph nodes or distant sites.
  • Cancer has spread to nearby lymph nodes but not to distant sites.
  • Cancer has spread to distant sites, such as bones, liver or lungs.

Next topic: How is bladder cancer diagnosed?