Staging is part of the cancer diagnosis process. It tells us if the cancer has spread, and how far. Is it in nearby lymph nodes? Is it in organs, tissues, or lymph nodes that are farther away?
The stage also tells us about the tumor’s location. Is it in the wall of the bladder, or in the muscle? How big is the tumor?
In addition to the cancer’s stage, we also describe a tumor as low grade or high grade.
Your doctor will review the results of your diagnostic and imaging tests. They may do a biopsy of your bladder. Then they will describe the type of bladder cancer you have, its stage, and its grade. They may adjust the stage if you have surgery or more tests.
MSK experts use the TNM system to describe the bladder cancer stage.
- T tells us how deep the tumor is in the bladder wall, and if it has spread to nearby tissue.
- N tells us if the tumor has spread to nearby lymph nodes.
- M tells us if the bladder cancer has metastasized (spread) to parts of your body farther away from your bladder.
The stage and grade help your doctor decide how to move forward with treatment and follow-up care at MSK.
For advanced bladder cancer that has spread, we use a test called MSK-IMPACT®. It gives us genetic information about your tumor that can guide your treatment.
There are 5 stages of bladder cancer, from 0 to 4. The lower the number, the less the cancer has spread.
Stage 0 Bladder Cancer
The scale starts at stage 0. It describes non-muscle-invasive bladder cancer. The disease is only found on the surface of the bladder’s inner linings. This stage is also known as in situ. In situ (in SY-too) are words in Latin that mean “in its original place.”
Stage 0 bladder cancer often is treated with transurethral resection bladder tumor (TURBT) to remove any tumors. You may then need follow-up monitoring, but no more treatment.
Or, you may have intravesical (IN-truh-VEH-sih-kul) therapy to treat cancer that has not spread outside the bladder lining. MSK offers several types of treatment for early-stage bladder cancer. They include forms of immunotherapy, bacillus Calmette-Guérin (BCG) therapy. It’s for people with high-risk, non-muscle-invasive bladder cancer diagnosed after TURBT.
Stage 1 Bladder Cancer
Stage 1 is non-muscle-invasive bladder cancer that only is in the bladder’s inner lining. It’s not in the bladder’s muscle wall.
Your treatment will start with transurethral resection bladder tumor (TURBT) surgery. This lets us learn more about the cancer and its stage and grade. We often do another TURBT surgery to make sure we completely removed the tumor and correctly staged it.
Next, you may be offered intravesical (IN-truh-VEH-sih-kul) therapy with either bacillus Calmette-Guérin (BCG) therapy or chemotherapy.
Stage 2 Bladder Cancer
Stage 2 cancer is still isolated in the bladder, but it’s in the muscle of the bladder wall. Treatment is based on the type of cell, your overall health, and your treatment goals.
We may recommend a partial or total (radical) cystectomy, also known as bladder removal. Some people may need chemotherapy before or after surgery, or immunotherapy after surgery.
Some people may be offered transurethral resection bladder tumor (TURBT) surgery followed by radiation and chemotherapy.
Stage 3 Bladder Cancer
Stage 3 describes a tumor that has spread through your bladder wall to nearby tissues or organs. It can also be in a lymph node near your bladder.
Treatment is often a total (radical) cystectomy, also known as bladder removal. You may have chemotherapy before and after this surgery.
Stage 4 Bladder Cancer
Stage 4 is advanced bladder cancer. It is metastatic bladder cancer, or cancer that has spread to distant lymph nodes or organs. Stage 4 also includes cancer that has spread outside your bladder into the wall of your abdomen or pelvis.
Treatments for stage 4 cancer usually are chemotherapy, targeted therapy, antibody drug conjugate therapy, or immunotherapy.
People with any stage of bladder cancer may be able to join a clinical trial. These research studies test new treatments to see how well they work.
Bladder Cancer Grades
We also divide bladder cancer into grades. The grade is low or high, depending on how the cells look under a microscope.
What Is low-grade bladder cancer
The cells almost look like normal cells. They often grow more slowly. They’re less likely to invade your bladder’s muscle wall than high-grade tumors.
What Is high-grade bladder cancer
The cells don’t look normal. They grow more quickly and are likely to spread.