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What are the Grades and Stages of Bladder Cancer?

If cancer cells are found, your doctor will need to know the tumor stage and grade. Then the health care team can develop a treatment plan.

Grading

The grade tells how fast the tumor can grow and spread. The most common grading systems use 2 main grades:

  • Low-grade tumors grow more slowly. Though they may come back (recur) after treatment, they rarely spread to the muscle of the bladder. They also don't often spread to other parts of the body. The cells of low-grade tumors have only minor differences from normal cells.
  • High-grade tumors grow more quickly. They often recur after treatment and are more likely to spread to other parts of the body. The cells are disorganized and look abnormal.

Staging

Your doctor must learn if cancer cells have spread. This is called staging. Your doctor wants to find out:

  • if the tumor entered the muscle of the bladder (stage T2 and higher)
  • if the tumor has entered nearby tissues (stage T3 and higher)
  • if the cancer has spread to other parts of the body (stage T4)

In general, a higher stage cancer (4 is the highest) is more serious. The table lists the stages using the TNM (Tumor, Node, Metastasis) system .


Staging of primary bladder cancer tumors (T)

Stages of Bladder Cancer
Stages of bladder cancer
Image © 2003 Fairman Studios, LLC.

Ta: Tumor on the bladder lining. Most are low grade and do not enter the bladder muscle. May recur, but often at the same stage and grade.


Tis: Also called carcinoma in situ (CIS) a high-grade cancer that appears as a flat, reddish, velvety patch on the bladder lining. Tis can progress to enter the muscle layer.


T1: The tumor goes into the bladder lining but often does not reach the muscle layer of the bladder. May recur at a higher grade and stage.


T2a and T2b: The tumor goes into the muscle layer of the bladder.


T3a and T3b: The tumor passed through the muscle layer and into the tissues surrounding the bladder. It may have reached the prostate, uterus, or vagina.


T4a and T4b: The tumor has spread to nearby lymph nodes or to other parts of the body away from the bladder (metastatic cancer).