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How Is Bladder Cancer Staged

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What Are Types Of Bladder Cancer

Grading/Staging of Bladder Cancer

There are two types of Superficial Bladder Cancer:

1) Papillary carcinoma

2) Flat carcinoma

Papillary carcinoma: Papillary Cancer, which grows thinner like projections, usually grows to the center of the Bladder, and it is known as Non- invasive papillary Cancer. A slow-growing non-invasive papillary does not refer to PUNLMP or urothelial neoplasm of the lower malignant Potential.

Flat carcinoma: it does not grow towards the center of the Bladder but remains in the inner part of the Bladder cells. It is known as flat Cancer in situ or non-invasive flat cancer.

Either if the cancer cells grow deeper into the bladder, it is called transitional cancer or carcinoma. Nearly 90% of bladder cancer is known as transitional cells cancer or known urothelial cancer. This type of cancer starts in the urothelial cells, which lay inside your Bladder, and the same type of cells can also be found in your urinary tract.

Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Location Of Bladder Cancer Tumors

The bladder wall is made up of several layers. From innermost to outermost these are:

  • The urothelium lining
  • The connective tissue underlying the urothelium
  • The muscle layer and
  • The fatty tissue surrounding the bladder within the pelvis.
  • Non-muscle invasive bladder cancer refers to tumors within the bladder wall that do not extend into the muscle layer. They may be in the urothelium only or may have spread into the connective tissue that underlies it.

    • Non-muscle invasive cancers that have not spread beyond the urothelium are sometimes referred to as superficial tumors. The two main types are:
      • Non-invasive papillary carcinoma : small, finger-like growths that project from the lining of the bladder towards the hollow center. Over time these tumors can grow into the bladder wall and spread to other parts of the body.
      • Non-invasive carcinoma in situ : a flat tumor that may appear as a red, velvet-like area on the bladder lining. This type of tumor has a high likelihood of progressing to invasive bladder cancer.
    • Non-muscle invasive cancers that have spread into the connective tissue underlying the urothelium but have not penetrated the muscle layer are referred to as category T1 tumors.

    Muscle invasive bladder cancer refers to tumors that have spread into or through the muscle layer of the bladder wall. Depending on the extent of their spread these tumors are assigned to one of the following categories:

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    Bladder Cancer Stage Groupings

    TNM stages can be grouped to provide a simplified, standard description of the cancer that enables the medical team to clearly communicate and plan treatment. In general terms, these stage groupings are:

    • Stage 0: Refers to tumors that have not spread beyond the bladders urothelium lining. These tumors are either papillary carcinoma or carcinoma in situ , as described above.
    • Stage 1: Refers to tumors that have reached the connective tissue underlying the urothelium but not penetrated the muscle layer of the bladder wall , or spread to lymph nodes or other organs.
    • Stage 2: Refers to tumors that have grown into the muscle layer of the bladder wall but not penetrated the fatty tissue surrounding the bladder , or spread to lymph nodes or other organs.
    • Stage 3: Describes bladder cancers that have spread to the fatty layer surrounding the bladder and/or to organs and lymph nodes within the pelvic cavity , but have not spread to the pelvic or abdominal wall, distant organs, or lymph nodes outside the pelvis.
    • Stage 4: Describes bladder cancers that have spread to the wall of the pelvis or abdomen, or that have metastasized to distant organs or lymph nodes outside the pelvis .

    What Are The Stages Of Bladder Cancer

    Smoking Promotes Bladder Cancer

    Bladder cancer can be either early stage or invasive .

    The stages range from TA to IV . In the earliest stages , the cancer is confined to the lining of the bladder or in the connective tissue just below the lining, but has not invaded into the main muscle wall of the bladder.

    Stages II to IV denote invasive cancer:

    • In Stage II, cancer has spread to the muscle wall of the bladder.
    • In Stage III, the cancer has spread to the fatty tissue outside the bladder muscle.
    • In Stage IV, the cancer has metastasized from the bladder to the lymph nodes or to other organs or bones.

    A more sophisticated and preferred staging system is known as TNM, which stands for tumor, node involvement and metastases. In this system:

    • Invasive bladder tumors can range from T2 all the way to T4 .
    • Lymph node involvement ranges from N0 to N3 .
    • M0 means that there is no metastasis outside of the pelvis. M1 means that it has metastasized outside of the pelvis.

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    Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

    Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the website.

    Bladder Cancer Diagnosis: Testing

    There is no single lab test that can specifically screen for and diagnose bladder cancer, even though urine tests may suggest that cancer is present. If a cancer is present, several tests may be abnormal, including urine cytology and tests for tumor marker proteins.


    A type of endoscopy, cystoscopy, is a procedure that allows visualization of the inside of the bladder through a thin, lighted tube that contains a camera. The instrument can also take small samples if abnormal areas are seen. A tissue biopsy is the most reliable way to diagnose bladder cancer.

    Urinalysis and Urine Cytology

    An analysis of the urine is a very useful test in the diagnosis of and screening for many diseases and conditions. The urinalysis will detect any abnormalities in the urine such as blood, protein, and sugar . A urine cytology is the examination of urine under a microscope while looking for abnormal cells that might indicate bladder cancer.

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    How Is Bladder Cancer Treated

    Treatment for bladder cancer will depend on the stage and type of cancer you have. Your provider will talk to you about treatment options and which plan of care is best for you.

    Superficial Bladder Cancer

    Superficial bladder cancer is bladder cancer that has not invaded into the muscle. It is often treated with surgery and intravesicular therapy.


    A TURBT is a surgical treatment in which a surgeon removes the bladder tumor using a tool placed into the body through the urethra. The extent of the disease is based mainly on findings during this test. TURBT is the main treatment for superficial disease since all of the tumor is often able to be removed. After a TURBT, you may have intravesicular therapy to prevent the cancer from coming back.

    Intravesicular Therapy

    Intravesicular therapy is when chemotherapy or immune therapy is injected directly into the bladder. This treatment destroys any remaining cancer cells. Both immunotherapy and chemotherapy medications can be used in intravesicular therapy.

    Bacillus Calmette-Guerin is an immunotherapy medication that is used. BCG is a type of virus that works to stimulate the immune system to destroy any cancer cells in the area. You will likely be given this medication multiple times. After treatment, you will have regular cystoscopies to monitor for any reoccurrence or new tumor development.

    Muscle Invading Bladder Cancer

    Bladder Preservation Therapy
    Radiation and Chemoradiation

    What Causes Bladder Cancer And Am I At Risk

    T1 Bladder Cancer

    Each year, about 83,730 new cases of bladder cancer will be diagnosed in the United States. It affects more men than women and the average age at diagnosis is 73.

    Cigarette smoking is the biggest risk factor for bladder cancer. About half of all bladder cancers are caused by cigarette smoking. Other risk factors for developing bladder cancer include: family history, occupational exposure to chemicals , previous cancer treatment with cyclophosphamide, ifosfamide, or pelvic radiation, the medication pioglitazone, exposure to arsenic , aristolochic , bladder infections caused by schistosoma haematobium, not drinking enough fluids, a genetic condition called Lynch Syndrome, a mutation of the retinoblastoma gene or the PTEN gene. and neurogenic bladder and the overuse of indwelling catheters.

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    Treatment Of Stages Ii And Iii Bladder Cancer

    For information about the treatments listed below, see the Treatment Option Overview section.

    Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    Stages And Grades Of Bladder Cancer

    Staging is the procedure of determining where the tumour is located, whether it has spread or not, and how it grows. While assessing the Stages of Bladder Cancer, many factors are taken into account, including how it is developing in the bladder, where it is growing and has it spread both inside and outside the bladder. In the case of bladder cancer, the stage is determined based on examining the sample removed during a TURBT and finding out whether cancer has spread to other parts of the body.

    Noninvasive v/s Invasive

    Noninvasive indicates that cancer is in the inner layers of the bladder, whereas invasive cancers are deepest in the layer of the bladder wall. If the cancer is said to be superficial or non-muscle invasive, that indicates it is not present in the bladders main muscle layerthough it may still be invasive or noninvasive and have the potential to spread to the muscle.

    TNM staging system

    The TNM system is the tool doctors use to describe the stage of Bladder cancer.

    • T is for tumour How large the tumour is and where is its location
    • N is for nodes Has cancer spread to lymph nodes, and if so, where and how many?
    • M is for metastasis Whether cancer has metastasized to other parts of the body distant from the bladder.

    There are five stages: stage 0 and stages I through IV .

    T categories for Bladder Cancer

    N categories of Bladder cancer

    M categories for Bladder cancer

    Bladder cancer stages

    Stage 0

    Stage 1

    • The TNM T1, N0, M0.

    Stage 2

    • The TNM -T2, N0, M0.


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    What Is Bladder Cancer

    The bladder, a hollow organ in the lower part of the abdomen, serves as a reservoir for urine until it is discharged out of the body through the urethra.

    There are different types of bladder cancer. The cancer cell type can be transitional cell carcinoma, squamous cell carcinoma or adenocarcinomaeach named for the types of cells that line the wall of the bladder where the cancer originates.

    • Most bladder cancers start from the transitional cells, which occupy the innermost lining of the bladder wall. The cancers, which originate in these cells lining the bladder can, in some instances, invade into the deeper layers of the bladder , the thick muscle layer of the bladder, or through the bladder wall into the fatty tissues that surround the bladder.
    • Squamous cells are thin flat cells that line the urethra and can form in the bladder after long bouts of bladder inflammation or irritation. Squamous cell carcinoma makes up about 5 percent of bladder cancers.
    • Adenocarcinoma is a very rare type of bladder cancer that begins in glandular cells in the lining of the bladder. Only 1 percent to 2 percent of bladder cancers are adenocarcinoma.

    Bladder Cancer: Stages Grades Symptoms And Treatments

    Bladder cancer

    The stage of cancer describes the measure of cancer and whether it has spread. Understanding the stages is necessary to determine the treatment you need. Just like how a dental professional can help determine the status of care your oral health may need if you are suffering from oral cancer. The same care and attention is needed if you are suffering from recurring urinary tract infections or disorders in the lower abdomen region. Keep reading to learn more about bladder cancer stages and their different treatment options.

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    What Are The Risk Factors Of Superficial Bladder Cancer

    • Nearly 70,000 new cases are of superficial Bladder cancer every year. Male Female radio is about 3:1, and the chance of developing superficial bladder cancer risk increases with age.
    • The most common risk factor for causing superficial bladder cancer is smoking.
    • Try to abuse phenacetin and analgesic.
    • Use of cyclophosphamide for the long term can be a suppressant.
    • Having chronic irritation due to a parasitic disease called schistosomiasis.
    • Long-term chronic irritation is called catheterization

    How Is Bladder Cancer Staged

    Cancer staging describes how much the cancer has grown and invaded the area, explaining the extent of the disease. Bladder cancer is often found at an early stage, as hematuria starts early in the course of the disease. Sometimes bladder cancer can advance to invasive disease before causing symptoms. To best understand staging, you need to know how cancer spreads and advances in stage.

    Cancers can spread and disrupt how normal organs work. Bladder cancers often begin very superficially, involving only the lining of the bladder. Bladder cancers can invade the bladder wall, involving the muscular layers of the wall. As bladder cancer grows it can invade the entire way through the wall and into the fat surrounding the bladder or even into other organs . This local extension is the most common way bladder cancer spreads.

    When cancer spreads to another area in the body, that area is called metastasis. Cancer can also spread through the lymph system and the bloodstream. Bladder cancer often spreads locally or to lymph nodes before spreading distantly, though this is not always the case. The lungs and bones are the most common areas for metastases to develop. When bladder cancer spreads to another area, it is still bladder cancer. For instance, if it spreads to the lung, it is not called lung cancer, but bladder cancer that has metastasized to the lung. If we look at the affected lung tissue under a microscope, it will look like bladder cancer cells.

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    Types Of Bladder Cancer

    Bladder cancers are named for the specific type of cell that becomes cancerous. Most bladder cancers are transitional cell carcinomas, named for the cells that line the bladder. Other less common types of bladder cancer are squamous cell carcinoma and adenocarcinoma.

    Transitional Cell Carcinoma

    Bladder cancer that begins inside the innermost tissue layer of the bladder, the transitional epithelium, is known as transitional cell carcinoma. This type of lining cell is are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional epithelium.

    There are two types of transitional cell carcinoma, low-grade and high-grade. Low-grade transitional cell carcinoma tends to come back after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body. High-grade transitional cell carcinoma also tends to come back after treatment and will often spread into the muscle layer of the bladder, other parts of the body, and the lymph nodes. High-grade diseases cause most bladder cancer deaths.

    Squamous Cell Carcinoma

    Squamous cells are thin, flat cells that may lead to bladder cancer after irritation or long-term infection.


    Adenocarcinoma cancers emerge from glandular cells in the lining of the bladder. Adenocarcinoma is a very rare form of bladder cancer.

    Treatments By Stages Of Bladder Cancer

    The Basics of Bladder Cancer and Treatment

    Non invasive and Non-muscle-invasive bladder cancer Stage 0a, 0is, 1

    Patients with low-grade noninvasive cancer are treated firstly with TURBT. Low-grade non-invasive cancer seldom turns into aggressive or metastatic cancer, but patients can have a chance to develop other low-grade cancer in the course of their life. To lower the risk of recurrence, patients may receive intravesical chemotherapy after TURBT.

    • People with high grade noninvasive , carcinoma in situ, or non-muscle invasive bladder cancer are most commonly treated with TURBT, followed by local intravesical Bacillus Calmette-Guerin. This combined treatment is given to narrow the risk of cancer recurrence or develop muscle-invasive cancer. Before going for BCG, patients need another TURBT to check that cancer has not spread to muscles.

    The first round of BCG is given for six weeks, once every week. Moving forward, the provider performs cystoscopy or bladder biopsy to check if cancer cells are eliminated. If cancer is gone, patients receive maintenance therapy with BCG, which is given once every three months for the first six months and then once every six months for 1 to 3 years. This will then be followed by long-term surveillance.

    • People with high-grade, non-muscle-invasive bladder cancer
    • People with high-risk, non-muscle-invasive bladder cancer

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    Muscle invasive Bladder cancer- Stage 2 and 3

    Bladder preservation

    Metastatic urothelial cancer- Stage 4

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