page_title: Bladder cancer
section_title: Staging
hierarchical_section_title: Bladder cancer / Diagnosis / Staging
context_page_description: Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain.
  Risk factors for bladder cancer include smoking, family history, prior radiation therapy, frequent bladder infections, and exposure to certain chemicals. The most common type is transitional cell carcinoma. Other types include squamous cell carcinoma and adenocarcinoma. Diagnosis is typically by cystoscopy with tissue biopsies. Staging of the cancer is determined by transurethral resection and medical imaging.
  Treatment depends on the stage of the cancer. It may include some combination of surgery, radiation therapy, chemotherapy, or immunotherapy. Surgical options may include transurethral resection, partial or complete removal of the bladder, or urinary diversion. The typical five-year survival rates in the United States is 77%, Canada is 75%, and Europe is 68%.
  Bladder cancer, as of 2018, affected about 1.6 million people globally with 549,000 new cases and 200,000 deaths. Age of onset is most often between 65 and 84 years of age. Males are more often affected than females.
context_section_description: Bladder cancer is staged (classified by the extent of spread of the cancer) and graded (how abnormal and aggressive the cells appear under the microscope) to determine treatments and estimate outcomes. Staging usually follows the first transurethral resection of bladder tumor (TURBT). Papillary tumors confined to the mucosa or which invade the lamina propria are classified as Ta or T1. Flat lesion are classified as Tis. Both are grouped together as non-muscle invasive disease for therapeutic purposes.
  In the TNM staging system (8th Edn. 2017) for bladder cancer:
  T (Primary tumour)
  TX Primary tumour cannot be assessed
  T0 No evidence of primary tumour
  Ta Non-invasive papillary carcinoma
  Tis Carcinoma in situ ('flat tumour')
  T1 Tumour invades subepithelial connective tissue
  T2a Tumour invades superficial muscle (inner half of the detrusor muscle)
  T2b Tumour invades deep muscle (outer half of the detrusor muscle)
  T3 Tumour invades perivesical tissue:
  T3a Microscopically
  T3b Macroscopically (extravesical mass)
  T4a Tumour invades prostate, uterus or vagina
  T4b Tumour invades pelvic wall or abdominal wall
  N (Lymph nodes)
  NX Regional lymph nodes cannot be assessed
  N0 No regional lymph node metastasis
  N1 Metastasis in a single lymph node in true pelvis (hypogastric, obturator, external iliac, or presacral nodes)
  N2 Metastasis in multiple lymph nodes in true pelvis (hypogastric, obturator, external iliac, or presacral nodes)
  N3 Metastasis in common iliac lymph nodes
  M (Distant metastasis)
  MX Distant metastasis cannot be assessed
  M0 No distant metastasis
  M1 Distant metastasis.
  M1a: The cancer has spread only to lymph nodes outside of the pelvis.
  M1b: The cancer has spread other parts of the body.
  The most common sites for bladder cancer metastases are the lymph nodes, bones, lung, liver, and peritoneum. The most common sentinel lymph nodes draining bladder cancer are obturator and internal iliac lymph nodes. The location of lymphatic spread depends on the location of the tumors. Tumors on the superolateral bladder wall spread to external iliac lymph nodes. Tumors on the neck, anterior wall and fundus spread commonly to the internal iliac lymph nodes. From the regional lymph nodes (i.e. obturator, internal and external lymph nodes) the cancer spreads to distant sites like the common iliac lymph nodes and paraaortic lymph nodes. Skipped lymph node lesions are not seen in bladder cancer.
  Numerical
  The stages above can be integrated into a numerical staging (with Roman numerals) as follows:
caption: Lymphatic drainage of the bladder (lateral view).Tumors on the superolateral bladder wall spread to external iliac lymph nodes
exif: {}