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The extent of the bladder cancer — how far it has spread — matters. Your care team needs to know if your cancer sits on or in the first lining of your bladder (non-muscle invasive), if it goes into the bladder muscle wall (muscle-invasive) or if it has spread to distant parts of your body (metastatic).
Staging your cancer is also important. Staging means finding out how far bladder cancer has spread in your body. Physicians group bladder cancers into stages I (1) through IV (4), with stage I being the least advanced and stage IV being the most advanced.
When your Fred Hutch Cancer Center team designs your treatment plan, they will consider the type and stage of your cancer along with many other factors. The stage is an important part of choosing which treatments are right for you.
Bladder Cancer Care Tailored to You
You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.
Bladder Cancer Stages
The stage depends on:
- whether the cancer is confined to the bladder's inner lining (non-muscle invasive)
- if the cancer goes into the bladder muscle wall (muscle-invasive)
- whether it has spread to distant parts of the body (metastatic)
We also compare the cancer cells to normal cells to tell the cancer grade. The grade helps your physicians predict how your bladder cancer will behave and how aggressive it is.
Stage 0
Cancer is only on the inner lining of the bladder.
Stage I (1)
Cancer has grown through the inner lining of the bladder to the layer below. It has not gone into the bladder muscle or other parts of the body.
Stage II (2)
Cancer has spread to the muscle wall of the bladder but not further.
Stage III (3)
Cancer has spread through the bladder muscle to other tissue. It may be in the fatty layer around the bladder, the prostate, the uterus or vagina or nearby lymph nodes.
Stage IV (4)
Cancer has spread further outside the bladder. It may be in the pelvic or abdominal wall, lymph nodes outside the pelvis or other parts of the body.
TNM Staging System
The TNM staging system is another way to describe how far bladder cancer has spread. This system is used for many other types of cancer too.
The letters stand for:
Tumor: The size of the main tumor and any spread of cancer into nearby tissue
Nodes: The number of nearby lymph nodes where cancer has spread
Metastasis: If cancer has spread (metastasized) to other parts of the body
In the TNM system, a symbol after each letter gives details; for example, T1N0M0.
In T1, the 1 indicates the size of the tumor (small). In N0, the 0 means there’s no sign of cancer in nearby lymph nodes. In M0, the 0 means cancer hasn’t spread to distant parts of the body. If you would like to know the stage of your cancer in the TNM system, ask your Fred Hutch care team.
How to Know Your Bladder Cancer Stage
As part of your diagnosis with bladder cancer, you will have imaging scans and other tests, like biopsies, to tell if the cancer has spread and where. In a biopsy, a tissue sample is removed with a needle and a pathologist checks to see if it contains cancer cells.
If you have had staging tests and already know the stage of your cancer before you come to Fred Hutch, we will look at the test results before your first appointment. If you have not had these tests, we will talk with you about which tests you need, why, how to get them and when you can expect results.
Staging Tests
Doctors use these methods to help diagnose bladder cancer and also tell if the cancer has spread.
- Microscopic urinalysis — testing your urine to help rule out infections and check for blood, sugar, bacteria or proteins that should not be there.
- Urine cytology — testing your urine to help find cancer cells. This is often done along with fluorescent in-situ hybridization (FISH) or protein tests.
- Physical exam — this includes an exam of your abdomen, back and rectum to feel for bumps that may be tumors. If you have a vagina, the exam also includes the vagina.
- Cystoscopy/ureteroscopy — putting a thin camera through your urethra to check your bladder and maybe your ureters. The doctor may also take a tissue sample (biopsy) to help tell the type and stage of the cancer.
- Transurethral resection of a bladder tumor (TUR or TURBT) — taking out the tumor and samples from other parts of your bladder. This is done through your urethra. A pathologist can then check the type of cancer and how deep it is in the tissue.
- Molecular profiling — checking the make-up of your cancer. This allows doctors to choose the most effective treatments and find clinical trials that may be right for you.
- Imaging tests — such as magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, X-rays, ultrasounds and bone scans. These tests help your doctors tell if cancer has spread beyond your bladder.
- Blue-light cystoscopy with hexaminolevulinate HCl — makes bladder tumors glow bright pink in blue light. The glow helps your provider see and remove the cancer.
How Bladder Cancer Treatment Varies by Stage
Treatment for bladder cancer can be very different from person to person. The stage of the cancer is also an important factor in a patient’s treatment plan.
In all the below scenarios, your medical team may discuss clinical trials that may be a good fit for your therapy plan.
At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support as needed. These include integrative medicine, nutrition counseling, physical and occupational therapy, emotional support and genetic counseling. It is our goal to help you and your family with both cancer prevention and cancer care, and to reduce symptoms caused by cancer or the treatments you receive.
Stage 0 and Stage I
The first treatment for stage 0 or stage I bladder cancer (non-muscle invasive cancer) is usually surgery to remove the tumor, without removing the bladder. You may also have chemotherapy or immunotherapy in your bladder to reduce the risk of cancer coming back.
Stage II
For stage II (muscle-invasive) bladder cancer that has not spread to distant parts of the body, patients often have complete surgery to remove the bladder, surrounding lymph nodes and to make a new path for urine to leave the body. It is possible that you may have systemic therapy such as chemotherapy or immunotherapy before this surgery. Some people can avoid bladder removal by having chemotherapy and radiation therapy administered around the same time.
Stage II and III
For stage II and stage III bladder cancer, two common treatments are radical cystectomy (surgery to remove the bladder and surrounding tissues and organs) or a combination of radiation therapy and chemotherapy.
Stage IV
For stage IV bladder cancer (locally advanced or metastatic cancer), the most common first treatment is systemic therapy with a combination of targeted chemotherapy and immunotherapy. Other treatments, like conventional chemotherapy and other therapies, may also be used at some point to help control cancer symptoms, shrink the tumor on imaging, slow down cancer growth, help you live longer, preserve your daily function and give you the best possible quality of life.
Researchers at Fred Hutch and beyond are always looking for better ways to treat advanced or metastatic bladder cancer. Clinical trials are going on to test new drugs or new combinations of drugs. In recent years, patients have benefited from newer targeted therapies and immunotherapies, like immune checkpoint inhibitors.