The stage and grade of cancer represent how far and how fast the cancer has grown. Care teams need to know the stage and the grade of cancer to predict the course of the disease and to make a treatment plan.
Staging Bladder Cancer
Stage measures the physical extent of the cancer. It’s a numerical rating of how far the cancer has grown into the bladder wall. Bladder cancer stages range from stage 0 to stage 4, where stage 0 means no growth into the bladder and stage 4 means it has grown through the bladder wall and perhaps to other parts of the body.
STAGE 0
A flat patch of cancer cells that hasn’t grown any farther than where it started. It’s still on the surface of the bladder lining and has yet to invade deeper layers. However, carcinoma in situ is fast-growing, aggressive, and can be very serious.
STAGE 1
Cancer cells have grown through the inner lining of the bladder wall and into the layer of connective tissue. But the cancer cells haven’t invaded the muscle layer of the bladder wall (non–muscle-invasive).
STAGE 2
Cancer cells have grown into the muscle layer (muscle-invasive), but have not reached the fatty layer covering the outside of the bladder nor has the cancer spread beyond the bladder.
STAGE 3
Cancer has grown through the bladder wall and into the fatty layer surrounding the bladder. It may also have spread to lymph nodes and organs nearby (in the pelvis). Stage 3 has two subgroups:
STAGE 3A
Bladder cancer may only be in the fatty tissue surrounding the bladder or it may have spread to a single nearby lymph node. It may also invade nearby reproductive organs, such as the prostate gland, uterus, or vagina. Stage 3A cancer has not spread to nodes or organs that are far from the bladder.
STAGE 3B
has the same traits as stage 3A but has spread to multiple lymph nodes in the pelvis. Stage 3B cancer has not spread to lymph nodes or organs far from the bladder.
STAGE 4
Cancer has grown through the bladder wall and may have spread to lymph nodes or organs far from the bladder. Stage 4 has two subgroups:
STAGE 4A
Cancer has invaded the wall of the pelvis or abdomen. Or, it has spread to lymph nodes far from the bladder.
STAGE 4B
Cancer has spread to far away lymph nodes and organs like the bones, liver, or lungs. Stage 4B is metastatic bladder cancer.
Grading Bladder Cancer
Grade measures the overall aggressiveness of the cancer. It’s an estimate of the rate that the cancer is growing. Cancer grade is either low grade (slow) or high grade (fast).​
​
To determine the grade of cancer, a sample of the tumor is studied in a laboratory by a pathologist. The pathologist will compare the cancer cells to normal cells. The more different the cells look, the higher the grade. The higher the grade, the faster the cancer is expected to spread. Tumor grade is not the same thing as cancer stage. Stage refers to how large a cancer tumor is and how far the cancer has spread.
Low Grade
Cell Appearance: The cancer cells look relatively similar to normal bladder cells, with only slight abnormalities.
​
Growth Behavior: Low-grade cancers tend to grow slowly and are less likely to spread or invade deeper layers of the bladder. wall.
​
Prognosis: Low-grade cancers are generally considered less aggressive, and while they may recur, they are usually less life-threatening. Treatment may involve more conservative approaches.
High Grade
Cell Appearance: The cancer cells appear much more abnormal and differ significantly from normal bladder cells.
​
Growth Behavior: High-grade cancers grow more quickly and are more likely to invade deeper into the bladder wall or spread to other parts of the body, such as lymph nodes or distant organs.
​
Prognosis: High-grade bladder cancers are more aggressive and require more intensive treatment.