Staging

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body. In a sense it is a measure of depth and extent of the disease.

The doctor may determine the stage of bladder cancer at the time of diagnosis, or may need to give the patient more tests. Such tests may include imaging tests - CT scan, magnetic resonance imaging (MRI), sonogram, intravenous pyelogram, bone scan, or chest x-ray. Sometimes staging is not complete until the patient has surgery.

These are the main features of each stage of the disease:

Stage 0
Cancer cells found only on the surface of the inner lining of the bladder; known as superficial cancer or carcinoma in situ (CIS).

Stage 1
Cancer cells found deep in the inner lining of the bladder, but not in the muscle of the bladder. Technically, while "invasive", this still counts as superficial bladder cancer since it can be removed through cystoscope surgery.

Stage 2
Cancer cells have spread to the muscle of the bladder.

Stage 3
Cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder. At this stage, the cancer may also have spread to the reproductive organs.

Stage 4
Cancer extends to the abdomen or pelvis. At this stage, the cancer may have also spread to the lymph nodes and even as far away as the lungs.

Grading

In addition to knowing the extent of the disease, it is also important to know whether the disease has intrinsic aggressive potential.

Under the microscope, the pathologist can determine this by looking at the individual cancer cells. Bladder cancer has traditionally been graded on a 3 to 4 point scale where grade 1 signifies a low-aggressive cancer and grade 3-4 signifies a high-aggressive cancer. Grade 2 is intermediate.

Recently, an attempt has been made by pathologists to adopt a simpler, more unified designation of simply low-grade or high-grade. The grade of the cancer is probably the single most important predictor of prognosis for superficial bladder cancers. Unfortunately, by the time the cancers have reached Stages II-IV, grade is less important since almost all of them are of the high-grade type. By definition, CIS is always high-grade.