Bladder Cancer Types, Stages and Grades

What are the types of bladder cancer tumors that may form?

Three types of bladder cancer may form, and each type of tumor can be present in one or more areas of the bladder, and more than one type can be present at the same time:

• Papillary tumors stick out from the bladder lining on a stalk. They tend to grow into the bladder cavity, away from the bladder wall, instead of deeper into the layers of the bladder wall.
• Sessile tumors lie flat against the bladder lining. Sessile tumors are much more likely than papillary tumors to grow deeper into the layers of the bladder wall.
• Carcinoma in situ (CIS) is a cancerous patch of bladder lining, often referred to as a “flat tumor.” The patch may look almost normal or may look red and inflamed. CIS is a type of nonmuscle-invasive bladder cancer that is of higher grade and increases the risk of recurrence and progression. At diagnosis, approximately 10% of patients with bladder cancer present with CIS.

What is Upper Tract Urothelial Carcinoma (UTUC)?

While the majority of bladder cancers (approximately 90-95%) arise in the bladder, the urothelial cells that line the bladder are found in other locations in the urinary system. Sometimes these urothelial cancers can occur in the lining of the kidney or in the ureter that connects the kidney to the bladder. This is known as upper tract urothelial cancer (UTUC) correspond to a subset of urothelial cancers that arise in the urothelial cells in the lining of the kidney (called the renal pelvis) or the ureter (the long, thin tube that connects that kidney to the bladder). Learn more about UTUC.

What is meant by “staging and grading” a tumor?

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body. Grade refers to what the cancer cells look like, and how many cells are multiplying. The higher the grade, the more uneven the cells are and the more cells are multiplying. Knowing the grade can help your doctor predict how fast the cancer will grow and spread.

Urologists typically send a sample of the cancer tissue to a pathologist, a doctor who specializes in examining tissue to determine the stage and grade of the cancer.  The pathologist writes a report with a diagnosis, and then sends it to your urologist.

What are the different “stages” for a bladder cancer tumor?

Stage suggests the location of the tumor in relation to the inner lining of the bladder. The higher the stage the further the tumor has grown away from its original site on the surface. The following are the stages for bladder tumors:

• T0: No tumor
• Ta: Papillary tumor without invading the bladder wall
• TIS (CIS): Carcinoma in situ (non-invasive flat high-grade (G3) cancer)
• T1: Tumor invades the connective tissue under the surface lining
• T2: Tumor invades the muscle layer
• T3: Tumor penetrates the bladder wall and invades the surrounding fat layer
• T4: Tumor invades other organs (i.e., prostate, uterus, vagina, pelvic wall)

 What are the different “grades” for a bladder cancer tumor?

Grade is expressed as a number between 1 (low) and 3 (high, i.e. G3); the higher the number the less the tumor resembles a normal cell. In lieu of numbers to grade a bladder cancer tumor, your doctor may refer to the tumor simply as low or high grade.

Watch Pathology Driving Decisions with Matthew Mossanen, MD, Guru Sonpavde, MD, and Kent Mouw, MD, PhD, from the  Dana-Farber Cancer Institute. 

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Information and services provided by the Bladder Cancer Advocacy Network (BCAN) are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, seek professional medical attention immediately! BCAN does not recommend or endorse any specific physicians, treatments, procedures or products even though they may be mentioned on this site.