Doctors classify bladder cancer according to the type and stage, from the earliest to the most advanced. When our doctors know the stage of the cancer, we can prepare a treatment plan that’s customized specifically to each person’s needs.
The stages of bladder cancer are based on the location and size of the tumor and how far it may have spread.
The main stages of bladder cancer are:
Stage 0 describes non-muscle-invasive bladder cancer. It is found only on the surface of the inner lining of the bladder. This stage is also known as in situ. Stage 0 bladder cancer is typically treated with transurethral resection (TUR), followed by either close follow-up without further treatment or intravesical therapy using bacillus Calmette-Guérin (BCG) therapy to try to keep the cancer from coming back.
Stage I describes superficial non-muscle-invasive bladder cancer. It is present in the bladder’s inner lining but hasn’t invaded the muscle wall. We usually perform an initial TUR to determine the extent of the cancer as well as the grade. We typically do a second TUR to remove the rest of the tumor followed by intravesical therapy with either BCG or chemotherapy.
Stage II cancer has invaded the muscle of the bladder wall but is still confined to the bladder. Depending on the extent and grade of the cancer, we may recommend a partial or total (radical) cystectomy. Some people may need chemotherapy before surgery. We may be able to remove the tumor with TUR followed by radiation and chemotherapy.
Stage III describes a tumor that has spread through the bladder wall to surrounding tissue or organs and possibly to lymph nodes near the bladder. This is usually treated with a radical cystectomy combined with chemotherapy before the surgery and sometimes after as well.
Stage IV cancer is the most advanced form of bladder cancer. It is called metastatic. This means the cancer has spread to distant lymph nodes or organs. Cancers that have spread beyond the bladder into the wall of the abdomen or pelvis are also considered Stage IV. Stage IV cancer is usually treated with chemotherapy and, more recently, with immunotherapy as well.
People with bladder cancer of all stages may be able to participate in a clinical trial. Clinical trials are research studies that test new treatments to see how well they work.
What is metastatic bladder cancer?
Metastatic (stage IV) bladder cancer has spread beyond the bladder to the wall of the abdomen or pelvis. It may also have spread to lymph nodes and distant sites in the body. It is usually treated with chemotherapy and, more recently, immunotherapy.
Bladder Cancer Grades
In addition to the stages, bladder cancer can be divided into low-grade or high-grade tumors. The grade refers to how the cells look under a microscope.
- Low Grade Bladder Cancer Low-grade bladder cancer cells are close in appearance to normal cells. They usually grow more slowly and are less likely to invade the muscle wall of the bladder compared with high-grade tumors.
- High Grade Bladder Cancer High-grade bladder cancer cells appear abnormal, grow more quickly, and are likely to spread.
Bladder Cancer Staging at MSK
Our doctors can tell you which stage and grade of bladder cancer you have after we’ve done a biopsy and completed any imaging studies that are needed. This staging process allows your care team to design a customized treatment plan for you. For bladder cancer that has spread, genetic information about the tumor obtained through MSK-IMPACT may guide treatment options.