Types and stages of bladder cancer
Like with most cancers, there are different types and stages of bladder cancer. If you have recently been given a diagnosis or are waiting to hear what’s changed following treatment, this page explains what the different terms mean. It can be a lot to take in so don’t feel that you have to read all this at once. You can order or download booklets which cover your diagnosis and speak to our helpline team or visit our forum. There are links at the bottom of this page with all the details.
More information on the types and stages of bladder cancer are available in our patient booklets (see link at the bottom of this page).
The most important thing to remember is that you are not alone. We are here to support you however we can.
Finding out your specific diagnosis
From the results of the biopsy taken during the TURBT, your consultant will be able to ascertain the type, stage and grade of your cancer. This is what will define whether your cancer is low, intermediate or high risk and determine the type of treatment you will be offered.
Both definitions and treatment options vary considerably, so it is important to take your time to discuss your situation with your doctor and make sure you understand your diagnosis and the treatment you are being offered. Keep asking questions until you understand fully.
If you have ANY queries about your diagnosis or treatment options, ask your team until you are completely sure.
Type
There are several different types of bladder cancer, the most common being transitional cell carcinoma (TCC) or urothelial cancer.
TCC begins in the cells of the bladder lining and can be non-muscle-invasive or muscle-invasive. If your cancer is non-muscle-invasive — also called superficial or early-stage bladder cancer — it has only been found on the lining of your bladder and has not spread elsewhere. If your cancer is muscle-invasive, it has spread into or beyond the muscle wall (the detrusor muscle).
Less common types of bladder cancer include squamous cell cancer, adenocarcinoma, urachal and small cell bladder cancer. These are usually muscle-invasive forms of cancer.
Stage
The tumour will have begun on the inner surface of the bladder, and the stage indicates how far it has spread from that inner lining.
A system called the TNM system is used to define the stage of the cancer.
1. T (tumour) – how far the tumour has grown into the bladder
2. N (nodes) – whether the cancer has spread into nearby lymph nodes
3. M (metastasis) – whether the cancer has spread into another part of the body, such as the lungs
The T stages
The T stages define how far the cancer has spread.
Bladder cancer up to the T1 stage is usually called non-muscle-invasive bladder cancer.
The T stages of non-muscle- invasive bladder cancer are:
- TO: no tumour
- TIS (CIS): carcinoma in situ, a flat, fast-growing tumour that spreads across the inner layer of the bladder
- Ta: papillary, mushroom- shaped, tumour that is only on the innermost layer of the bladder
- Ti: tumour has started to grow into the connective tissue
Although CIS is a type of non-muscle- invasive cancer, it is of an aggressive form which may spread more quickly than other types, so it is always classed and treated as high grade. T1 cancer is also high grade.
If the tumour grows further than this, it’s usually called muscle-invasive bladder cancer.
The T stages of muscle-invasive bladder cancer are:
- T2: tumour has grown through the connective tissue into the bladder muscle
- T3: tumour has grown through the layer of muscles into the surrounding fat layer
If the tumour grows further than the T3 stage, it’s considered to be advanced bladder cancer.
The T stage of advanced bladder cancer is:
- T4: tumour has spread outside the bladder into other organs (such as prostate, uterus, vagina, pelvic wall)
2. The N stages
The N stages define the cancer in relation to its spread to the lymph nodes:
- NO: there are no cancerous cells in any of your lymph nodes
- Ni: there are cancerous cells in one of the lymph nodes in your pelvis
- N2: there are cancerous cells in two or more of the lymph nodes in your pelvis
- NS: there are cancerous cells in one or more of the lymph nodes (known as common iliac nodes)deep in your pelvis
3. The M stages
There are only two definitions in the M system, relating to the further spread of the cancer:
- MO: the cancer has not spread to another part of the body
- M1: the cancer has spread to another part of the body, such as the bones, lungs or liver
Grade
The grade refers to what the cancer cells look like under the microscope compared to healthy tissue and indicates how aggressive the cancer is and how likely it is to spread. It is also affected by the number of tumours.
To classify bladder cancers, the World Health Organisation established one System in 1973, and then established a slightly different system in 2004.
In the 1973 grading system, grades are expressed as a number; the higher the number, the less the tumour resembles a normal cell and therefore the more aggressive it is.
- G1/ low grade
- G2/intermediate grade
- G3/high grade
Your doctor may simply refer to the grade of your tumour as low, intermediate or high.
In the 2004 system, the categories are:
- PUNLMP (Papillary Urothelial Neoplasm of Low Malignant Potential)
- Low grade
- high grade
The boundaries of the three systems are not the same.
Tumour grading can seem complex – your CNS (Clinical Nurse Specialist) will be able to talk you through everything in more detail.
Support for you
Please remember that you can contact us at any time for support, whether you are a patient or care for someone who is.
Our helpline is open from 0900-1630, Monday to Friday. There’s an answerphone if we’re busy, but we will call you back as soon as we can. Call 01844 351 621 or email info@fightbladdercancer.co.uk
Talking to other people who have had the same tests, investigations and diagnosis can help. Our private online forum on Facebook is available 24/7, 365 days a year. Find out how to join and other ways you can talk to patients and carers via our getting support page.
More information
Download PDFs of the booklets mentioned on this page. If you would like a free copy sent to you by post or email, add your details to our booklets order form and we’ll get them to you.
