Grading and Staging of Bladder Cancer
Grading and staging of any tumor are critical to the patient and the doctors in selecting the proper treatment.
Grading of tumors by the pathologist, after the tumor has undergone biopsy and resection, provides information about the potential behavior of the tumor. Low grade (Grade 1) tumors look more like normal bladder cells, and tend to remain on the surface of the bladder lining, while the high grade (Grade 3) tumors have much angrier looking cells and tend to shed cells into the urine, and are more likely to invade into the bladder surface.
Staging is the process of finding out how extensive or widespread the cancer is. This is very important because the treatment and the outlook for your recovery depend on the stage of the cancer. The microscopic examination of the tumor biopsies shows the depth of invasion into the bladder wall, which determines the clinical stage of the tumor.
The most superficial disease, confined to the mucosal surface, is called Ta, when there is a visible tumor polyp, or Tis(in-situ), when the tumor is flat. Tumor invading into the next layer of the bladder (lamina propria) is called T1. The tumors that invade into bladder muscle are termed T2, through bladder wall into surrounding fat is T3, and invading neighboring structures is called T4.
To further assess the extent of disease, an intravenous pyelogram (IVP) would evaluate the kidneys and ureters, as about 8 percent of patients with bladder tumors will also have tumors in the upper urinary tract. CT Scan of the abdomen and pelvis may demonstrate enlarged lymph nodes, which drain the bladder, blockage of the kidneys, as well as possible spread to other organs.
TNM (Tumor Nodes Metastases) Staging System
Primary Tumor Staging: T
T0: No tumor present
Tis: Carcinoma in situ, "flat tumor"
Ta: Papillary tumor, with only bladder mucosa involved, non-invasive
T1: Invasion into subepithelial connective tissue (lamina propria)
T2a: Invasion into bladder superficial muscle
T2b: Invasion into bladder deep muscle
T3: Invasion into fat surrounding bladder
T4a: Regional spread into prostate, vagina, uterus
T4b: Tumor fixed to pelvic or abdominal wall
TX: Unable to assess primary tumor
Lymph Node Staging: N
N0: No lymph node involvement found
N1: Single unilateral regional node involvement
N2: Contralateral or bilateral lymph nodes involved
N3: Fixed mass of regional lymph nodes
N4: Juxtaregional lymph node involvement
NX: Regional lymph nodes cannot be assessed
Distant Metastatic Spread Staging: M
M0: No distant metastasis identified
M1: Distant metastasis found
MX: Distant metastases cannot be assessed
After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. The staging is a complex system of rating the extent of the tumor itself, whether it has spread to the lymph nodes, and whether it has metastasized (or spread) to parts of the body outside of the bladder. Your clear understanding of the staging will help both you and your doctor decide on the best treatment for you.
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