Grading And Staging - Action Bladder Cancer UK

CATEGORIES OF BLADDER CANCER

Bladder cancers fall into five broad categories based on their grade and stage - a full explanation of these terms can be found below:

• Low risk non-muscle invasive bladder cancer These are small (less than 3cm), single low grade Grade 1 or Grade 2) bladder cancers that haven't grown beyond the inner layer of the bladder. They are usually described as papillary (or mushroom like) and are called pTa - where the p indicates that this has been found out by biopsy.
• Intermediate risk non-muscle invasive bladder cancer These are larger (greater than 3cm) or multiple low grade pTa bladder cancers. Small, single low grade pT1 tumours are also in this category where T1 indicates that the cancer has grown a little further into the bladder wall. Also if low risk tumours keep growing back they fall into this category.
• High risk non-muscle invasive bladder cancer These are Grade 3 pTa or pT1 bladder cancers. All larger (greater than 3 cm) or multiple T1 tumours are also included. Carcinoma in Situ (CIS - where the cancer is present as a patch on the inner lining of the bladder) is also in this category.
• Muscle invasive bladder cancer These are bladder cancers which are pT2 or pT3 which indicates that the cancer has grown further into the bladder wall and is found in the inner muscle layer.
• Advanced bladder cancer These are bladder cancers which are pT4 which indicates that it has grown through the bladder wall or have spread to nearby lymph nodes to varying degrees - referred to as N1, N2 or N3) or to other sites in the body referred to as M1.

The majority of bladder cancers fall into either the low or intermediate risk non-muscle invasive category. These cancers are rarely life-threatening but unfortunately commonly grow back requiring surveillance and repeat treatments. Treatments for patients in these two categories are aimed at keeping and protecting your bladder.

High risk non-muscle invasive cancer is more difficult to treat and can progress to something more serious if not treated successfully. The most common treatment currently is called Immunotherapy (where BCG vaccine is used to encourage your immune system to ‘fight' the cancer) or, if that is either not appropriate or doesn't work it may be necessary to remove your bladder to avoid it spreading further.

If you have been diagnosed with muscle-invasive or advanced bladder cancer, a stage T2, T3 or T4 cancer, the cancer will have grown into the outer muscle layer of the bladder or beyond. You may have been diagnosed straight after your first operation to remove your cancer tumour - referred to as a TURBT or Transurethral Resection of a Bladder Tumour or surveillance of a non-muscle invasive cancer which shows it has spread. In either case, your clinician will very likely carry out further cancer staging and more intensive treatment which usually includes having to remove your bladder.