These tests help show whether you have bladder cancer, how far the cancer has grown into the layers of the bladder, and if the cancer has spread outside the bladder. This is called staging. The staging system most commonly used is the TNM system, which stands for tumour-node-metastasis.
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Staging
Using this information, the doctor may describe the cancer as:
| Superficial bladder cancer | This is also called non-muscle-invasive bladder cancer or NMIBC. The cancer cells are found only in the inner lining of the bladder (urothelium) or the next layer of tissue (lamina propria) and haven’t grown into the deeper layers of the bladder wall. |
| Muscle-invasive bladder cancer (MIBC) | The cancer has spread beyond the urothelium and lamina propria into the layer of muscle (muscularis propria), or sometimes through the bladder wall into the surrounding fatty tissue. MIBC can also sometimes spread to lymph nodes close to the bladder. For treatment information, see Muscle-invasive bladder cancer treatment and for ways to collect urine after surgery, see Having a urinary diversion. |
| Advanced bladder cancer | The cancer has spread (metastasised) outside of the bladder into distant lymph nodes or other organs of the body. For more on this see Advanced bladder cancer treatment. |
TNM staging system
The most common staging system for bladder cancer is the TNM system. In this system, letters and numbers are used to describe the cancer, with higher numbers indicating larger size or spread.
| T stands for tumour | Ta, Tis and T1 are superficial bladder cancer, while T2, T3 and T4 are muscle-invasive bladder cancer. |
| N stands for nodes | N0 means the cancer has not spread to the lymph nodes; N1, N2 and N3 indicate it has spread to lymph nodes. NX means it is unknown. |
| M stands for metastasis | M0 means the cancer has not spread to distant parts of the body; M1 means it has spread to distant parts of the body. MX means it is unknown. |
Some doctors put the TNM scores together to produce an overall stage, from stage 1 (earliest stage) to stage 4 (most advanced).
Grade and risk category
The biopsy and/or TURBT results will show the grade of the cancer. This is a score that describes how quickly a cancer might grow.
Knowing the grade helps your urologist predict how likely the cancer is to come back (recur) or grow into deeper layers (progress), and if you will need further treatment after surgery.
The grade may be described as:
| Low grade | The cancer cells look similar to normal bladder cells and are usually slow-growing. They are less likely to invade and spread. |
| High grade | The cancer cells look very abnormal and grow quickly; they are more likely to spread both into the bladder muscle and outside the bladder. |
In superficial bladder cancers, the grade may be low or high, while almost all muscle-invasive cancers are high grade. Carcinoma in situ (stage Tis in the TNM system) is a high-grade tumour that needs to be treated quickly to prevent it invading the muscle layer.
Risk category
Based on the stage, grade and other features, a superficial bladder cancer will also be classified as having a lower or higher risk of returning after treatment or spreading into the muscle layer. Knowing the risk category will help your doctors work out which treatments to recommend.
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.
In general, the earlier bladder cancer is diagnosed, the better the outcome. To work out your prognosis, your doctor will consider:
- your test results
- the type of bladder cancer
- the stage, grade and risk category
- how well you respond to treatment
- other factors such as your age, fitness and medical history.
My diagnosis was made after the biopsy. I felt relieved to finally have a label for my illness
Dee
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Dr Prassannah Satasivam, Urologist and Robotic Surgeon, Epworth Hospitals and Cabrini Hospitals, VIC; Donna Clifford, Urology Nurse Practitioner, Royal Adelaide Hospital, SA; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Renee Finnigan, Radiation Oncologist, Gold Coast University Hospital, QLD; Lisa Hann, 13 11 20 Consultant, Cancer Council SA; Dr Andrew Hirschhorn, Director of Allied Health and MQ Health Academy, MQ Health, Macquarie University, NSW; Anne Marie Lyons, Stomal Therapy Nurse, Concord Hospital and NSW Stoma Limited, NSW; John McDonald, Consumer; Prof Manish Patel, Urological Cancer and Robotic Surgeon, Westmead Hospital, Macquarie University Hospital, and The University of Sydney, NSW; Dr Jason Paterdis, Urological Surgeon, Brisbane Urology Clinic, QLD; Graeme Sissing, Consumer; Prof Martin Stockler, Medical Oncologist, The University of Sydney, Concord Cancer Centre, and Chris O’Brien Lifehouse RPA, NSW.
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