Stages of Bladder Cancer and Survival Rates

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All organs of our body are important, including bladder. It has important function to store urine (waste product of the body) produced by kidney. And cancer can significantly impair the function of this organ. The bladder cancer survival rates are closely associated with several factors, particularly the stages of the disease. What else you need to know?

You might also like to read the previous posts about the symptoms of bladder cancer and effectiveness of BCG to treat this kind of cancer, before continuing!

In general, a cancer in the bladder that is diagnosed early has better prognosis and relatively easier to treat than when it is found /diagnosed at later stages. Other factors that usually affect the prognosis of patient are type of cancer, overall health and age of patient.

What are stages of bladder cancer?

Staging the cancer is a standard procedure to find how far the cells of cancer have spread. It is one the most crucial variables in determining the best treatment options and analyzing a patient’s outlook for recovery and prognosis (survival).

According to the American Cancer Society, there are generally two types in staging this kind of cancer:

Clinical stage! In making diagnosis of bladder cancer, doctors /specialists need to perform several tests. These include biopsies, CT scans or ultrasound test (imaging tests), physical exams, and cystoscopy. The results of these tests also can be used by doctors to determine the stage of cancer.
Pathologic stage! It is usually used after surgery. In other words, it also uses the combination of the same test results (such as imaging tests, biopsies, etc), plus with the information that is found during surgery of removing cancer, affected bladder, and affected nearby lymph nodes.

In general, the pathologic stage is more accurately predict the outlook of patient for survival, since this type is based on specific information that found at surgery.

AJCC TNM system

TNM staging system is recommended by AJCC (the American Joint Committee on Cancer). It is most often used in staging cancer in the bladder. And the information of this TNM system can be used to determine the overall stage of cancer.

As the name implies, TNM system consists of 3 major variables; ‘T’ - ‘N’- and ‘M’. Each letter contains crucial information to determine how far the cancer cells have spread.

‘T’ part of TNM

It can tell us how far the cancer in the bladder has grown and more information about the main tumor. The letter T is followed by certain letters /numbers. Below is a helpful table about the T stages for bladder cancer!

Table source: the Cancer Research UK

In addition; imaging tests (like MRI scan or CT scan), closely analyzing the bladder under anaesthetic, and biopsies are some common procedures to help specialists determine the T stages.

‘N’ part of TNM

This category is used to describe whether or not the cancer cells have spread to the nearby lymph nodes. The procedure of surgery is often used to determine the N stages, but sometimes only with some imaging tests.

For this category, the Letter N is followed by certain numbers /letters which include:

NX! It means that there is no adequate information about whether or not the cancer has spread to the nearby lymph nodes.
N0! It means that no any cancer cells found in any nearby lymph nodes.
N1! It can describe that a single lymph node inside the hip bones (in the pelvis - in the lower part of the tummy) has been affected.
N2! It describes that there are 2 or more affected lymph nodes in the true pelvis.
And N3! It means that the cancer cells have spread to the lymph nodes in the groin.

Additionally, when the cancer has spread to the distant lymph nodes then it is now considered metastasis (or often known as ‘M’ category of TNM staging system).

‘M’ part of TNM

In the TNM staging system, this category is the most advanced stage.

M0 -- It has not spread to other distant parts of the body.
M1 -- Unlike M0, M1 describes when the cancer cells have spread to distant organs /parts of the patient’s body. Liver, lungs, bones, distant lymph nodes are common distant sites that affected in this category.

Overall bladder cancer stages

After all categories of TNM system (‘T’, ‘N’, and ‘M’) have been determined, then doctors can use the combination of this information to determine the overall cancer stage (with stage 0 is the earliest, and stage IV is the most serious /advanced stage).

Stage 0

In general, this can be divided into 2 major groups: (a) stage 0a -- In TNM staging system, it is a condition for Ta, N0, and M0, and (b) stage 0is -- it represents Tis, N0, and M0 in TNM staging system.

Both are non-invasive papillary carcinoma and describes the earliest stage of cancer, and there is still no any lymph node that affected by the cancer.

Stage 1 (I)

It is the same with T1, N0, and M0 in the TNM staging system. The cancer cells now have spread into the connective-tissue’s layer under the bladder’s lining layer, but they still not affect /reach the layer of muscle in the wall of bladder. Furthermore, they also still not affect any lymph nodes.

Stage 2 (II) - T2a or T2b, N0, and M0!

Now the thick muscle layer of bladder wall is affected, but the cancer cells have not completely passed through the muscle to achieve the layer of fatty tissue that encircles the bladder. The lymph nodes and distant sites have not been affected.

Stage 3 (III)

It is a condition for ‘T4a, T3b, or T3a’, N0, and M0 in TNM staging system. The cancer cells have completely grown through the bladder (T3).

Even they may also have spread outside bladder - prostate and womb may already be affected. But they have not spread to distant sites or lymph nodes. Moreover, abdominal wall and pelvic are also still not affected!

Stage 4 (IV)

This can be one of the following conditions:

T4b, N0, and M0! It means the cancer cells have grown through the abdominal wall and pelvic (T4b). But there is still no sign of distant spread, and cancer cells also have not spread to the lymph nodes!
M0, N1-N3, and any T! The nearby lymph nodes have been affected (N1 to N3), but there is still no sign of distant spread.
M1, any N, and any T! There is sign of distant spread (M1). Common distant sites that may be affected are distant lymph nodes, lungs, liver, or bones.

Bladder cancer survival rates

Before continuing, you need to completely understand that there is no any statistic that can tell you what will happen. In other words, each case of cancer (including for bladder cancer) is unique.

The survival time of a patient may be much lower or even higher, depending on the characteristics of tumor (such as stage, type, and grade of cancer) and specific conditions of patient (such as age and overall health of patient).

The following is a table from the National Cancer Institute's SEER about the 5 year survival rate for bladder cancer: