TNM stages

The T part of TNM tells you how far into the bladder the cancer cells have grown.
Doctors find the T stage by a combination of looking at the grade of the cancer
cells after a biopsy, examination of the bladder under anaesthetic, and a CT or
MRI scan.

The T stages are:

    â€¢ CIS – very early, high grade, cancer cells are detected
        only in the innermost layer of the bladder lining
    â€¢ Ta – the cancer is just in the innermost layer of the
        bladder lining
    â€¢ T1– the cancer has started to grow into the connective
        tissue beneath the bladder lining
    â€¢ T2 – the cancer has grown through the connective tissue
        into the muscle
    â€¢ T2a – the cancer has grown into the superficial muscle
    â€¢ T2b – the cancer has grown into the deeper muscle
    â€¢ T3– the cancer has grown through the muscle into the fat layer
    â€¢ T3a – the cancer in the fat layer can only be seen under a
        microscope (microscopic invasion)
    â€¢ T3b – the cancer in the fat layer can be seen on tests, or
        felt by your doctor during an
        examination under anaesthetic (macroscopic invasion)
    â€¢ T4 – the cancer has spread outside the bladder
    â€¢ T4a – the cancer has spread to the prostate, womb (uterus) or vagina
    â€¢ T4b – the cancer has spread to the wall of the pelvis or abdomen

There are four lymph node stages in bladder cancer. The lymph nodes can be seen and
measured on a CT or MRI scan, or may be found if you need surgery to remove your bladder.

The N stages are:

    â€¢ N0 – no cancer in any lymph nodes
    â€¢ N1 – there is cancer in one lymph node in the pelvis
        (the lower part of your tummy,between your hip bones)
    â€¢ N2 – there is cancer in more than one lymph node in the pelvis
    â€¢ N3 – there is cancer in one or more lymph nodes in the groin

It is also possible for bladder cancer to spread to lymph nodes in the abdomen
(above the pelvic area) or to lymph nodes in the neck.

If you have cancer in any lymph nodes, your doctor may want you to have
chemotherapy treatment before surgery.

The M stages are M0 and M1

As with most cancers, there are two stages for cancer spread or metastases (M). Either
the cancer has spread to another body organ (M1) or it hasn't (M0). If bladder cancer
does spread to another part of the body, it is most likely to go to the bones, lungs or
liver. If your cancer has spread, you have advanced bladder cancer.

Your doctor may talk to you about the grade of your cancer. This means how well
developed the cells look under the microscope.

    â€¢ Low grade cancers have cells that look very like normal cells
        â€“ they are called low grade or well differentiated
        and tend to grow slowly and are not likely to spread
    â€¢ High grade cancers have cells that look very abnormal
        â€“ they are called high grade or poorly differentiated
        and are more quickly growing and more likely to spread

If you have early bladder cancer, grade is one thing that your doctor may take into
account when deciding your treatment. If the cells are high grade, you are more likely
to need further treatment to stop the cancer coming back after your specialist has
removed it. Carcinoma in situ tumours of the bladder are high grade.