Bladder Cancer Stages

Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It’s important to know the stage of bladder cancer to plan treatment.

There are several different staging systems for cancer. Bladder cancer is usually staged using the TNM staging system. Your cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage is assigned to your cancer, such as stage I, stage II, stage III, or stage IV (may also be written as stage 1, stage 2, stage 3, or stage 4). When talking with you about your cancer, your doctor may describe it as one of these stages.

Learn more about Cancer Staging.

Learn about the tests and procedures doctors use to stage bladder cancer.

Stage 0 (noninvasive papillary carcinoma and carcinoma in situ)

Stage 0 refers to noninvasive bladder cancer. This means that cancer cells are found in tissue lining the inside of the bladder but have not invaded the bladder wall. Stage 0 is divided into stages 0a and 0is, depending on the type of tumor:

• Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths extending into the bladder lumen (the space where urine collects). Stage 0a can be low grade or high grade, depending on how abnormal the cells look under the microscope (see the section on Bladder cancer grade).
• Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder. Stage 0is is always high grade (see the section on Bladder cancer grade).

Learn about treatment for stage 0 bladder cancer.

Stage I bladder cancer

Stage I is a form of non-muscle-invasive bladder cancer that has spread into the connective tissue but has not reached the muscle layers of the bladder.

Learn about treatment for stage I bladder cancer.

Stage II bladder cancer

Stage II may also be described as muscle-invasive bladder cancer. In stage II, cancer has spread through the connective tissue into the muscle layers of the bladder.

Learn about treatment for stage II bladder cancer.

Stage III bladder cancer

Stage III may also be described as locally advanced bladder cancer. Stage III is divided into stages IIIA and IIIB.

• In stage IIIA
  • cancer has grown all the way through the bladder muscles and bladder wall into the layer of fat surrounding the bladder and may have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina) but has not spread to lymph nodes; or
  • cancer has spread to one lymph node in the pelvis that is not near the major arteries in the pelvis, called the common iliac arteries.
• In stage IIIB, cancer has spread to more than one lymph node in the pelvis that is not near the common iliac arteries or to at least one lymph node that is near the common iliac arteries.

Learn about treatment for stage III bladder cancer.

Stage IV bladder cancer

Stage IV is divided into stages IVA and IVB.

• In stage IVA
  • cancer has spread to the abdominal wall or pelvic wall; or
  • cancer has spread to lymph nodes that are above the major arteries in the pelvis, called the common iliac arteries.
• In stage IVB, cancer has spread to other parts of the body, such as the lung, bone, or liver.

Stage IV bladder cancer is also called metastatic bladder cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the lung, the cancer cells in the lung are actually bladder cancer cells. The disease is called metastatic bladder cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Learn about treatment for stage IV bladder cancer.

Bladder cancer grade

Cancer grade describes how abnormal the bladder cancer cells look under a microscope and how quickly the cancer cells are likely to grow and spread. Your doctor uses grade and other factors about your cancer, such as its stage, to form a treatment plan and in some cases, to estimate your prognosis.

• Low-grade bladder cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells.
• High-grade bladder cancer tends to grow and spread more quickly than low-grade bladder cancer. High-grade cancers usually have a worse prognosis than low-grade cancers and may need treatment right away or treatment that is more aggressive

To learn more, see Tumor Grade.

Recurrent bladder cancer

Recurrent bladder cancer is cancer that has recurred (come back) after it has been treated. Bladder cancer tends to recur after treatment, even when it is noninvasive at the time of diagnosis. Low-grade bladder cancer mainly recurs in the bladder lining. High-grade bladder cancer is more likely to have spread to the muscle layers or other parts of the body when it recurs. Tests will be done to help determine where the cancer has returned in your body, if it has spread, and how far. The type of treatment that you have for recurrent bladder cancer will depend on where it has come back.

Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in Coping with Bladder Cancer and the booklet When Cancer Returns.

Learn about treatment for recurrent bladder cancer.