Before starting bladder cancer treatment, your care team needs to understand the extent the cancer has grown and whether it’s spread to other areas. This process is called staging and it’s an important step that provides a roadmap for choosing the safest and most effective approach for your diagnosis. Doctors use several tools to determine the stage:
- Cystoscopy, where a small camera is inserted into the bladder to look for tumors.
- Imaging tests, such as CT scans, MRI, or ultrasound, to see whether the cancer has spread to nearby tissues, lymph nodes, or distant organs.
- Biopsy and pathology, sometimes done during cystoscopy or surgery, to examine how deeply the cancer has invaded the bladder wall.
Below is an overview of the different stages to help you understand what each one means.
Stage 0:
Stage 0 cancers are confined to the inner lining of the bladder. This stage is also known as non-invasive bladder cancer because the cancer hasn’t invaded the bladder wall. Within stage 0, there are two subtypes.
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- Stage 0a (Papillary carcinoma): Grows outward into the bladder but stays in the lining.
Stage 0is (Carcinoma in situ): Flat, aggressive cancer confined to the bladder lining.
You may notice blood in your urine or urinary changes, but some people have no symptoms. Treatment usually involves surgically removing the tumor and is sometimes combined with additional medication that’s placed directly into the bladder.
Stage I
In stage I, the cancer has grown into the connective tissue beneath the bladder lining but not into the muscle. This stage is sometimes referred to as non-muscle invasive.
Symptoms can include blood in the urine, painful urination, or more frequent urination. Surgery, often via TURBT, may be sufficient, and in some cases, intravesical therapy is recommended to reduce recurrence.
Stage II
The cancer has spread to the muscle layer of the bladder wall (muscle invasive), but not beyond to the fatty layers. In this stage, the cancer is still confined to the bladder.
You might notice urinary changes or blood in your urine, and your care team will likely recommend surgery (partial or full bladder removal) and possibly chemotherapy before or after surgery to reduce the chance of the cancer returning.
Stage III
Stage III means the cancer has spread through the bladder muscle into the surrounding tissues or nearby organs. The two substages help describe whether the cancer has reached the lymph nodes.
- Stage IIIA: Cancer has spread into the fat surrounding the bladder or into nearby organs such as the prostate, uterus, or vagina, but has not reached the lymph nodes.
- Stage IIIB: Cancer has spread to nearby pelvic or abdominal lymph nodes, in addition to the nearby organs.
Symptoms may include blood in the urine, pelvic pain, or changes in urination. Treatment usually involves a combination of surgery and chemotherapy, and sometimes radiation, depending on your situation.
Stage IV
Stage IV bladder cancer means the cancer has spread to lymph nodes or distant organs such as the liver, lungs, or bones. This stage is separated into two substages.
- Stage IVA: Cancer has spread to nearby organs and lymph nodes, but not to distant organs.
- Stage IVB (metastatic bladder cancer): Cancer has spread to distant lymph nodes or other organs such as the liver, lungs, or bones.
Symptoms may be more pronounced and can include pain, swelling, unexplained weight loss, fatigue, or urinary obstruction. Treatment focuses on controlling the cancer and improving quality of life, using a combination of chemotherapy, immunotherapy, targeted therapies, surgery, or radiation to manage symptoms.
Why Staging Matters
Staging gives your care team a clearer idea of what treatment options are best for your diagnosis. Other important factors, such as your age, overall health, personal values, the tumor’s grade (how aggressive it looks under the microscope), and your preferences, also play a big role in deciding the best approach. Shared decision-making with your care team is key.
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