In addition to determining the grade of the tumor, the pathologist will determine the stage of the tumor, which refers to the extent of the cancer and therefore the chances that it has spread beyond the bladder. The pathologist looks at how deep the tumor invades into the bladder wall. If the cancerous cells are only found in the first layer of the bladder wall (the urothelium), then the cancer is called superficial. If the cells penetrate beyond this into the deeper muscle of the bladder wall, then it is called invasive.
Tumor describes the primary tumor.
- TX: The tumor cannot be assessed.
- T0: No evidence of tumor exists.
- Ta: The tumor is noninvasive papillary carcinoma that will not spread.
- Tis: The tumor is confined to the lining of bladder.
- T1: The tumor has spread to the tissue under the bladder lining.
- T2: The tumor has spread to the bladder muscle.
- T3: The tumor has spread to the tissue on the out-side of the bladder.
- T4: The tumor has spread to prostate, uterus, vagina, pelvic wall, or abdominal wall.
Nodes describe whether cancer has spread into the lymph nodes in the pelvis.
- NX: The lymph nodes in the pelvis cannot be examined.
- N0: No bladder cancer is found in lymph nodes.
- N1: Bladder cancer is found in one lymph node, 2 cm (0.8 in.) or less in dimension.
- N2: Bladder cancer is found in one or more lymph nodes, none more than 5 cm (2 in.) in dimension.
- N3: Bladder cancer is found in one or more lymph nodes, more than 5 cm (2 in.) in dimension.
- Metastasis describes the extent of cancer spread out-side of the pelvic region.
- MX: The spread of cancer to other organs cannot be evaluated.
- M0: No evidence of bladder cancer exists elsewhere in the body.
M1: Bladder cancer cells are found somewhere else in the body. The stage is very important in determining the treatment that you will receive. There is a good barrier between the urothelium and the muscle of the bladder wall. If the tumor is kept within this barrier, the tumor can usually be completely removed with a transurethral resection of bladder tumor (TURBT) . If the tumor has become more aggressive, it may figure out how to pass through this barrier. When the tumor has gotten through the protective layer, it becomes much more likely to spread outside of the bladder to other organs or lymph nodes.
Once the tumor has got-ten through the urothelium, simple scraping of the tumor is not likely to get all of the tumor out, and further therapy will be necessary—either surgery, chemotherapy, or radiation. The option that you and your doctor choose will depend on the extent of spread of the tumor and your overall health status. Over the years, several different systems have been used to stage cancers. In an effort to ease confusion between different systems, doctors around the world met and decided to create a new staging system that would be relevant for all different types of cancer. This system is called TNM. The letters stand for Tumor size, lymph Node status, and the extent of Metastases.
It took me about 6 months to finally figure out what this was. All doctor said was, “ You have a T2N0 tumor.” I’m thinking, “Well, is that good?” I wrote it down on a napkin that I had and kept it in my purse. A few months later, I showed it to my son, who looked it up for me. As it turns out, it is pretty good, as much as any of this is good. (S. R., 68 years old)