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Bladder Cancer Treatment (PDQ®)

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Stages of Bladder Cancer

After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body.

The process used to find out if cancer has spread within the bladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. To stage bladder cancer, the CT scan may take pictures of the chest, abdomen, and pelvis.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the bone, the cancer cells in the bone are actually bladder cancer cells. The disease is metastatic bladder cancer, not bone cancer.

The following stages are used for bladder cancer:

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

Stage 0 bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. First inset shows papillary carcinoma on the inner lining of the bladder. Second inset shows carcinoma in situ on the inner lining of the bladder. Also shown are the layers of connective tissue and muscle tissue of the bladder and the layer of fat around the bladder.
Stage 0 bladder cancer. Abnormal cells are found in the tissue lining the inside of the bladder. Stage 0a may look like tiny mushrooms growing from the lining of the bladder. Stage 0is is a flat tumor on the tissue lining the inside of the bladder.

In stage 0, abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:

Stage I

Stage I bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder and in the layer of connective tissue next to it. Also shown are the muscle layers of the bladder and the layer of fat around the bladder.
Stage I bladder cancer. Cancer has spread to the layer of connective tissue next to the inner lining of the bladder.

In stage I, cancer has formed and spread to the layer of connective tissue next to the inner lining of the bladder.

Stage II

Stage II bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder, the layer of connective tissue, and the muscle layers. Also shown is the layer of fat around the bladder.
Stage II bladder cancer. Cancer has spread to the layers of muscle tissue of the bladder.

In stage II, cancer has spread to the layers of muscle tissue of the bladder.

Stage III

Stage III bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder, the layer of connective tissue, the muscle layers, and the layer of fat around the bladder.
Stage III bladder cancer. Cancer has spread from the bladder to the layer of fat surrounding it. It may also have spread to the prostate and/or seminal vesicles in men or the uterus and/or vagina in women.

In stage III, cancer has spread from the bladder to the layer of fat surrounding it and may have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina).

Stage IV

Stage IV bladder cancer; drawing shows cancer in the bladder, the pelvic wall, and lymph nodes. Inset shows some other parts of the body where cancer can spread from the bladder: the lung, liver, and bone.
Stage IV bladder cancer. Cancer has spread from the bladder to (a) the wall of the abdomen or pelvis, (b) one or more lymph nodes, and/or (c) other parts of the body, such as the lung, liver, or bone.

In stage IV, one or more of the following is true:

  • Updated: October 21, 2014