Bladder Cancer Staging

According to recent consensus decisions of the American Joint Committee on Cancer (AJCC), the stage groupings of bladder cancers are as follows:

Individuals with Grade 1, Stage 0 tumors usually do not need any additional workup for staging, because there is little risk of metastasis. By contrast, individuals with more advanced tumors, for example, Grade 2, Stage 2 tumors, require a routine staging assessment. Such an assessment should include basic blood work, chest X-ray, lower body imaging by either computed tomography (CT scan) or magnetic resonance imaging, and a bone scan.

Ta (papillary, noninvasive carcinoma)

"Ta" tumors are papillary (wart-like) in nature. They often look like pink cabbages, and they may be present in groups. Ta tumors are confined to the inner surface of the bladder wall and are distinguished from T1 tumors because they have not broken through the basement (supporting) membrane.

TIS (carcinoma in situ; flat, pre-invasive tumor)

Carcinoma in situ (CIS) of the transitional epithelium — otherwise known as TIS — is very rare. In the past, TIS tumors were associated with high death rates because they often were undiagnosed. Unlike papillary tumors, TIS tumors are flat. The cancerous cells in TIS tumors are pre-invasive (confined to the basement membrane). When detected in the urine by Pap staining, TIS cells appear anaplastic (lacking cellular differentiation - the distinguishing characteristics of a cell). In middle-aged men, TIS may resemble cystitis without hematuria. Accurate diagnosis depends upon biopsy of the mucosa in any patients with unexplained cystitis or sterile pyuria (no microorganisms are present but there is "pus-like" matter in the urine).

T1 (tumor invasion of connective tissue)

During clinical inspection, T1 tumors often look like Ta tumors. These cancers may appear as an isolated mass, or they may be present in groups. But the distinctive feature of the T1 tumor is that—although it has broken through the basement membrane into the connective tissue of the bladder-lining mucous membrane (lamina propria)—the stalk of the tumor has not invaded the muscle below. Some physicians believe that T1 tumors should not be considered "superficial TCC," because they have the potential to be invasive and to progress. T1 tumors have a progression rate of roughly 30%. In T1 lesions of Grade 3 or Grade 4, nearly half of all tumors progress.

T2 (tumor invasion of muscle)

T2 tumors are characterized by the invasion of the muscle surrounding the bladder. If only the inner half of "superficial" muscle is affected (T2a tumor) and tumor cells are well-differentiated, the tumor may not have gained access to the lymphatic system. However, if the tumor has penetrated the outer half of "deep" muscle (T2b tumor) and cells are poorly differentiated, then the patient's prognosis usually is worse.

T3 (tumor invasion of perivesical tissue)

When a tumor has broken through the surrounding muscle and begins to invade the perivesical tissue (fatty tissue around the bladder) or peritoneum (membrane lining the abdominal cavity) outside of the bladder, it is classified as a T3 tumor. If the process of invasion has just begun and only can be seen by microscopy, then the tumor is classified as T3a. However, if the tumor is visibly massed on the outer bladder tissue, then it is classified as T3b.

T4 (tumor invasion of surrounding organs)

If a tumor has progressed to invade nearby organs—such as the prostate (a male gland that surrounds the bladder neck and urethra and adds a secretion to the semen), uterus (womb), vagina (female reproductive canal), or walls of the abdomen or pelvis (hip bone)—it is classified as T4. T4 tumors are, by and large, inoperable, meaning they can/should not be surgically removed. They may cause painful symptoms, hematuria, frequent urination, and sleeplessness. In addition, the necrotic (dead) tissue within the bladder often becomes infected. Surgery may be performed not as a cure, but as a method to reduce suffering in patients with T4 tumors.

Publication Review By: Richard Levin, M.D., F.A.C.S., Stanley J. Swierzewski, III, M.D.

Published: 14 Jun 1998

Last Modified: 02 Sep 2015