Types of Bladder Cancer – Staging, Grading, and More

November 28, 2017

First things first

You hear the term bladder cancer and your mind immediately enters the danger zone. Your body goes numb; time stands still. You’re well aware that it’s a horrid disease that’s impacted the lives of millions, but your worry and concern increases tenfold when it hits close to home.

Suddenly, you’re searching the web in search of some optimistic answers, frantically questioning Google to seek out bladder tumor symptoms and is bladder cancer painful because, of course, pain can often be the worst part of anything; not just cancer. But worry will mend no wounds — save that job for Dr. Shaw, whose expertise is not only utilized at the Austin Urology Institute, but at the top bladder cancer hospitals in the city of Austin.

But first things first: Gather the necessary information to better understand the safest and most opportune way in which to proceed.


Bladder cancer is one of the most common cancers in the U.S. In 2018, approximately 81,190 new cases of bladder cancer will be diagnosed in the United States. Approximately half of all bladder cancers are found while the cancer remains confined to the inner layer of the bladder wall. This is called non-invasive or in situ cancers. About one in three bladder cancers have invaded into deeper layers of the bladder. Most other cases, cancer has spread to nearby tissues or lymph nodes outside the bladder. Very rarely, it has spread to distant parts of the body.=

How is bladder cancer diagnosed?

How is bladder cancer diagnosed, you may ask? There are a multitude of methods that can be used to determine a diagnosis, but the most common is a Biopsy/Transurethral resection of bladder tumor — often referred to as a TURBT. A Cystoscopy is another option, as is a simple urine test.

Once bladder cancer is diagnosed, it is important to find out if it has spread (metastasized), and if so, how far. This is called staging. The stage of a cancer describes the extent of the cancer in the body, which helps determine the best bladder cancer treatment options. It’s also important to identify the type of cancer and its grade.

Bladder cancer staging

Bladder cancer staging, which, of course, is the process in which the stages of bladder cancer is determined, is complex and takes into account many pieces of information. The staging system will include the type of cancer, how far it has spread into the bladder muscle, if it has invaded the nearby lymph nodes and tissues and if it has spread (metastasized) to organs and lymph nodes far away from the bladder.

Staging is done by using additional tests including biopsies, imaging (CT, MRI, PET) and the results of surgery and pathology. The American Joint Committee on Cancer (AJCC) established a universal staging system: the TNM system. This system is based on three key pieces of information: the tumor growth, if lymph nodes are involved, and the spread of the cancer.

(T) Tumor:

How far the main tumor has grown into the bladder wall and nearby tissues?

  • TX: The primary tumor cannot be evaluated.
  • T0 (T plus zero): There is no evidence of a tumor in the bladder.
  • Ta: Non-invasive papillary carcinoma. This type of growth often is found on a small section of tissue that easily can be removed with surgery.
  • Tis: This stage is carcinoma in situ (CIS) or a “flat tumor.” This means that the cancer is only found on or near the surface of the bladder. It is also called non-muscle-invasive bladder cancer, superficial bladder cancer, or noninvasive flat carcinoma.
  • T1: The tumor has spread to the connective tissue, but it does not involve the bladder wall muscle.
  • T2: The tumor has spread to the muscle of the bladder wall.

T2a: The tumor has spread to the superficial muscle of the bladder.

T2b: The tumor has spread to the deep muscle of the bladder.

  • T3: The tumor has grown into the fatty tissue that surrounds the bladder.

T3a: The tumor has grown into the fatty tissue that surrounds the bladder, but is only detected by a microscope.

T3b: The tumor has grown into the fatty tissue that surrounds the bladder and is large enough to be seen on imaging or to be seen/felt by the doctor.

  • T4: The tumor has spread to any of the following: the abdominal wall, the pelvic wall, a man’s prostate or seminal vesicles or a woman’s uterus or vagina.

T4a: The tumor has spread to the prostate, seminal vesicles, uterus, or vagina.

T4b: The tumor has spread to the pelvic wall or the abdominal wall.

(N) Node:

Is there any cancer in the lymph nodes near the bladder?

  • NX: Lymph nodes near the bladder cannot be evaluated.
  • N0 (N plus zero): Cancer has not spread to lymph nodes near the bladder.
  • N1: Cancer has spread to a single lymph node in the pelvis
  • N2: Cancer has spread to two or more lymph nodes in the pelvis.
  • N3: Cancer has spread to lymph nodes near major arteries near the bladder.

(M) Metastasis:

Has the cancer spread (metastasized) to distant organs or lymph nodes?

  • M0 (M plus zero): There is no metastasis. The cancer has not spread.
  • M1: There is distant metastasis. The cancer has spread.

M1a: The cancer has only spread to the lymph nodes outside the pelvis.

M1b: The cancer has spread to other parts of the body.

Staging: Putting TNM together

The stage of the bladder cancer is determined by combining the T, N and M classifications.

  • Stage 0a: This is an early cancer. It is only found on the surface of the inner lining of the bladder. Cancer cells are grouped together and can often be easily removed. The cancer has not invaded the muscle or connective tissue of the bladder wall. This type of bladder cancer is also called noninvasive papillary urothelial carcinoma (Ta, N0, M0). It is typically referred to as low-grade.
  • Stage 0is: This stage of cancer, also known as a flat tumor or carcinoma in situ (CIS), is found only on the inner lining of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder (Tis, N0, M0). This is a high-grade cancer and considered an aggressive disease because it can often grow and lead to muscle-invasive disease.
  • Stage I: The cancer has grown through the inner lining of the bladder and into the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).
  • Stage II: The cancer has spread into the thick muscle wall of the bladder. It is also called invasive cancer or muscle-invasive cancer. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs (T2, N0, M0).
  • Stage III: The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder (prostate, uterus, vagina). Or, the cancer has spread to the nearby lymph nodes.
  • Stage IIIA: The cancer has grown into the tissue surrounding the bladder or has spread to the prostate, uterus, or vagina, but has not spread to the lymph nodes or other organs (T3a, T3b, or T4a; N0; M0), or the cancer has spread to a single regional lymph node (T1 to T4a, N1, M0).
  • Stage IIIB: The cancer has spread to two or more regional lymph nodes or lymph nodes further away (T1 to T4a, N2 or N3, M0).
  • Stage IV: The tumor has spread into the pelvic wall or abdominal wall, or the cancer has spread to lymph nodes outside of the pelvis or to other parts of the body.


In addition to staging cancer, it also graded. It is graded based on the possibility of the cancer recurring, growing or spreading (progressing).

  • Low-grade: the cancer cells look similar to the healthy tissue and are different cell groups. This is called differentiated or low-grade cancer.
  • High-grade: the cells look very different from healthy tissues. It’s then classified as poorly differentiated or high-grade cancer meaning it is more likely to recur and grow.  

Types of Bladder Cancer

Bladder cancer develops when cells in the bladder begin to grow abnormally and form a tumor. Different types of cells in the bladder can become cancerous. The different types of bladder cancer are dependent upon where the cancer begins. Knowing the cell type in addition to the stage and grade can also help determine which treatments may work best.

  • Urothelial carcinoma, also called transitional cell carcinoma (TCC), occurs in the cells that line the inside of the bladder. These same cells line the inside of the ureters and the urethra, as well.
  • Squamous cell carcinoma is associated with chronic irritation of the bladder. This can be due to chronic infections, long-term use of a urinary catheter or by a rare parasitic infection called schistosomiasis. Squamous cell bladder cancer is rare in the United States.
  • Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United States.
  • Some bladder cancers include more than one type of cell.

The trifecta of staging, grading and typing bladder cancer allows for the obtaining all information needed in order to outline treatment options and communicate best with all medical providers that may be involved in the bladder cancer treatment plan. If you’re concerned that you or someone you know and love may be battling bladder cancer — however early it may be — contact Dr. Shaw at the Austin Urology Institute at 512-694-8888, and begin traveling your road to recovery.