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  • Staging, grading and prognosis of bladder cancer

    Contents

    Prognosis

    Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of the disease. Bladder cancer can usually be effectively treated, especially if it is found before it spreads outside the bladder.

    To work out your prognosis, your doctor will consider test results, the type of bladder cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as your age, fitness and medical history.

    Staging 

    To help plan treatment, tumours are given a stage to describe the extent of the cancer in the body. The most common staging system for bladder cancer is the TNM system.

    In this system, letters are assigned numbers to describe the cancer – Ta, Tis and T1 are considered non-muscle-invasive bladder cancer, while T2, T3 and T4 are muscle-invasive bladder cancer.

    Another way of staging cancer is with numbers. There are four main stages: stage 1 is the earliest cancer and stage 4 is the most advanced. However, this method is not used often for bladder cancer.

    Grading

    The biopsy results will also tell your doctor about the grade of the cancer. This describes how quickly a cancer might grow. Knowing the grade helps your specialist predict how likely the cancer is to come back (recur) and if you need further treatment after surgery.

    Low grade – The cancer cells look similar to normal bladder cells, are usually slow-growing and are less likely to invade and spread. Most bladder tumours are low grade.

    High grade – The cancer cells look very abnormal and grow quickly. They are more likely to spread both into the bladder muscle and outside the bladder.

    In non-muscle-invasive tumours, the grade may be low or high, while almost all muscle-invasive cancers are high grade.

    Carcinoma in situ (stage Tis in the TNM system) is a high-grade tumour that needs immediate, and sometimes aggressive, treatment to prevent it invading the muscle layer.

    Which health professionals will I see?

    Your GP will usually arrange the first tests to assess your symptoms. If these tests don’t rule out cancer, you’ll be referred to a urologist or to a local hospital that specialises in urology. The urologist will examine you and may do more tests. A range of health professionals will work as a multidisciplinary team (MDT) to treat you.

    The following health professionals may be in your MDT. Note that only some patients see a cancer care coordinator. If the bladder cancer is non-muscle-invasive, you are unlikely to need systemic chemotherapy or radiation therapy, so you probably won’t have to see a medical oncologist or radiation oncologist.

    This website page was last reviewed and updated September 2019

    Information reviewed by: Phil Dundee, Urological Surgeon, Epworth Hospital, VIC; David Connah, Consumer; Dr Elizabeth Hovey, Senior Staff Specialist, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, and Conjoint Senior Lecturer, University of New South Wales, NSW; Colleen McDonald, Clinical Nurse Consultant Urology, Westmead Hospital, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia, WA; Kerry Santoro, Urology Nurse Consultant, Repatriation General Hospital, SA. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.

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