Staging and Grading
Staging of bladder cancers is based on how deeply a tumor has penetrated the bladder wall. In general there are 2 stages each with their own treatment modalities. Superficial, which include all tumors that do not invade the muscle wall and invasive cancers which have invaded the bladder muscle. Treatments within these broad categories may vary based on tumor grading (aggressiveness).
TNM Staging System
The most commonly used system for staging bladder cancer is the TNM Systems developed by The American Joint Committee on Cancer.
Click for a table which describes the TNM staging system in more detail.
The majority of cancers I see fall in either the Ta, Tis, and T1 stages.
Stages Ta and Tis (in the urothelium) and stage T1 (in the lamina propria) are the non-muscle-invasive stages. Most Ta tumors are low grade, and most do not progress to invade the bladder muscle. Stage T1 tumors are much more likely to become muscle-invasive. Stage Ta tumors often recur after treatment but they tend to recur with the same stage and grade. The Tis stage classification is reserved for a type of high-grade cancer called carcinoma in situ (CIS). CIS usually appears through the cystoscope as a flat, reddish, velvety patch on the bladder lining. It is difficult to remove and is best treated with immunotherapy or chemotherapy. If untreated, CIS will likely progress to muscle-invasive disease.
Grading
When a tissue sample reveals bladder cancer, the examining pathologist will grade the tumor taking into account the extent to which the affected cells differ in appearance from normal cells. These grades also indicate a tumor’s “aggression level’ - how fast it is likely to grow and spread. The most widely accepted grading systems use “low, intermediate and high” rating scales to classify these tumors:
Low-grade tumors have cells with minimal abnormalities and lower incidence of progression.
High-grade tumors show cells that have become disorganized. Many abnormalities are apparent. High-grade tumors are the most aggressive and the most likely to progress into the muscle of the bladder wall.
My Take
Grading and staging are very complex aspects of assessing your disease. I would recommend you concentrate on putting together your team and exploring treatment options.