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Bladder cancer

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Staging bladder cancer

Staging is a way of describing or classifying a cancer based on the extent, or amount, of cancer in the body. The most common staging system for bladder cancer is the TNM system.

  • T describes the size of the primary tumour and if it has grown into tissues around the bladder.
  • N describes the number and location of any lymph nodes around the bladder that have cancer cells in them.
  • M describes whether or not the cancer has spread, or metastasized, to other parts of the body.

Doctors give bladder cancer a clinical stage (TNM) based on the results of diagnostic tests. Doctors use the clinical stage to make treatment decisions.

The pathological stage (pTNM) is based on examining the tumour and other tissues after they are removed during surgery. The pTNM corresponds to the TNM categories. The pathological stage is more accurate than the clinical stage. Doctors use it to help them make a prognosis.

Stage grouping for bladder cancer

Overall stage, or stage grouping, is based on the TNM system. Each stage is given a number from 0 to 4 (stages 1 to 4 are usually given as the Roman numerals I, II, III and IV). Generally, the higher the number, the farther the cancer has progressed. Your healthcare team uses the stage grouping to plan treatment and estimate prognosis.

When describing the stage, doctors may use the terms localized, regional and distant. Localized means that the cancer is only in the area where it started and has not spread to other parts of the body. Regional means close to or around the bladder. Distant means in a part of the body farther from the bladder.

Stage 0

The following describes all stage 0 bladder cancer.

StageTNMExplanation

stage 0a

Ta

This is non-invasive papillary urothelial carcinoma.

The tumour has grown toward the hollow centre of the bladder but has not grown into the connective tissue or muscle of the bladder wall.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the bladder).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage 0is

Tis

This is non-invasive flat urothelial carcinoma (also called carcinoma in situ).

The tumour is only in the lining of the bladder. It has not grown into the hollow centre of the bladder or the connective tissue or muscle of the bladder wall.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the bladder).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage I

The following describes all stage I bladder cancer.

StageTNMExplanation

stage I

T1

The tumour is invasive. It has grown into the connective tissue (lamina propria) but has not grown into the muscle of the bladder wall.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the bladder).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage II

The following describes all stage II bladder cancer.

StageTNMExplanation

stage II

T2a

The tumour is invasive. It has grown into the inner half of the muscle of the bladder wall.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the bladder.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage II

T2b

The tumour is invasive. It has grown into the outer half of the muscle of the bladder wall.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the tumour).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage III

The following describes all stage III bladder cancer.

StageTNMExplanation

stage III

T3a

The tumour is invasive. It has grown into the fatty tissue around the bladder but can only be seen through a microscope.

N0

The cancer has not spread to lymph nodes.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage III

T3b

The tumour is invasive. It has grown into the fatty tissue around the bladder and can be seen on imaging tests or be felt by the surgeon.

N0

The cancer has not spread to lymph nodes.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage III

T4a

The tumour is invasive. It has grown into the prostate, seminal vesicles, uterus or vagina.

N0

The cancer has not spread to lymph nodes.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage IV

The following describes all stage IV bladder cancer.

StageTNMExplanation

stage IV

T4b

The tumour is invasive. It has grown into the pelvic wall or the abdominal wall.

N0

The cancer has not spread to lymph nodes.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage IV

any T

The tumour may be T1, T2, T3 or T4:

It has grown into the connective tissue (lamina propria) but has not grown into the muscle of the bladder wall (T1).

It has grown into the muscle of the bladder wall (T2).

It has spread to the fatty tissue around the bladder (T3).

It has grown into the prostate, seminal vesicles, uterus, vagina, pelvic wall or abdominal wall (T4).

N1, N2 or N3

The cancer has spread to regional lymph nodes (cancer cells are present in lymph nodes near the bladder tumour).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage IV

any T

The tumour may be T1, T2, T3 or T4.

It has grown into the connective tissue (lamina propria) but has not grown into the muscle of the bladder wall (T1).

It has grown into the muscle of the bladder wall (T2).

It has spread to the fatty tissue around the bladder (T3).

It has grown into the prostate, seminal vesicles, uterus, vagina, pelvic wall or abdominal wall (T4).

any N

The cancer may have spread to one or more regional lymph nodes.

M1

The cancer has spread to distant areas of the body.

Recurrent bladder cancer

Recurrent bladder cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, which is called metastatic bladder cancer.

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