Bladder cancer types, stages and grades

Bladder cancer types, stages and grades describe how the cancer looks, how far it has spread, and how aggressive it is. Types refer to tumor appearance and cell origin, stages range from 0–4 based on spread, and grades indicate how abnormal the cancer cells are. Together, they guide treatment decisions and prognosis. 

What are bladder cancer types, stages and grades?

Bladder cancer is classified in three key ways: 

• Type: The form and origin of the tumor (e.g., urothelial carcinoma)  

• Stage: How far the cancer has spread (0–4)  

• Grade: How abnormal and aggressive the cancer cells appear  

These classifications help doctors: 

• Choose the most effective treatment 
• Predict how the cancer may behave  
• Estimate risk of the cancer coming back or getting worse  

What are the main types of bladder cancer tumors? 

Bladder cancer tumors can appear in different forms: 

Urothelial carcinoma

• Accounts for most bladder cancers  
• Begins in cells lining the bladder 

Other (more rare) types include: adenocarcinoma, squamous cell carcinoma and primary bladder sarcomas.

Are there subtypes of urothelial carcinoma? 

Sometimes, the common form of bladder cancer, urothelial carcinoma, can develop characteristics of other cell types. This is often reported on pathology reports as “differentiation.”

Common types of differentiation include:

• squamous differentiation (most common)
• glandular differentiation

Rarer subtypes include:

•  small cell/neuroendocrine
• micropapillary
• sarcomatoid
• plasmacytoid

Having one of these subtypes can change the treatment recommended by your doctor. 

What are tumor growth patterns?

Urothelial tumors often form in three distinct ways:

• Carcinoma in situ (CIS)  
  • Flat, high-grade tumor  
  • Appears as a red, inflamed patch  
  • Higher risk of growing or spreading 
•  Papillary tumors  
  • Grow in finger-like projections  
  • Often remain on the bladder surface 
• Sessile tumors 
  • Flat and solid  
  • More likely to grow into deeper layers 

How is bladder cancer staged? 

Bladder cancer staging describes how deeply the tumor has grown and whether it has spread. 

Stage 0 bladder cancer (non-invasive)

• T0: No tumor found 

• Ta: Papillary tumor without invading the bladder wall 

• Tis (CIS): Carcinoma in situ 

Carcinoma in situ 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 non-muscle 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.

Learn more in BCAN’s recorded webinar, Understanding carcinoma in situ (CIS) bladder cancer.

Stage 1 bladder cancer

• T1: Tumor invades the connective tissue under the surface lining 

• Has not reached the muscle layer. Instead, it is found in the connective tissue just beneath the lining  

• Still considered non-muscle invasive 

Stage 2 (muscle-invasive bladder cancer – MIBC) bladder cancer

T2: Tumor invades the muscle layer 

Key facts: 

• ~25–30% of bladder cancers reach this stage  
• Higher risk of spread 

Stage 3 bladder cancer

T3: Tumor spreads through the bladder wall into the surrounding fat  

May reach nearby organs:  

• Prostate (men)  

• Uterus or vagina (women) 

Stage 4 bladder cancer (Advanced or Metastatic)

Cancer spreads to: 

• Nearby organs or pelvic wall  

• Distant parts of the body 

What are bladder cancer grades?

Grade describes how abnormal cancer cells look under a microscope. 

• Low-grade (Grade 1)  

• Cells look more like normal cells  

• Grow slowly  

• High-grade (Grade 3)  

• Cells look very abnormal  

• Grow quickly and spread more easily  

 Grade helps predict: 

• Tumor aggressiveness  

• How likely the tumor is to come back 

• Treatment approach  

How do stage and grade affect treatment decisions? 

Doctors use both stage and grade to guide care: 

• Early-stage + low-grade 
  • Often treated with medications put into the bladder, called “intravesical therapy”
• Low stage + high grade
  • patients may be initially managed with localized (intravesical) therapies
  • may require surgery to remove the bladder if those localized treatments fail
  • may require upfront surgery depending on the type of tumor

• Higher-stage or high-grade 
  May require:  
  • surgery  
  • chemotherapy  
  • radiation

Understanding these factors helps patients make informed decisions about care. 

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.

Frequently asked questions about bladder cancer types, stages and grades 

What is the most common type of bladder cancer? 

Urothelial carcinoma is the most common type of bladder cancer. It begins in the cells lining the inside of the bladder and accounts for the majority of cases. 

What does stage 0 bladder cancer mean? 

Stage 0 bladder cancer means the tumor is only on the surface of the bladder lining and has not invaded deeper tissues. It is considered non-muscle invasive. 

Is muscle-invasive bladder cancer more serious? 

Yes. Muscle-invasive bladder cancer has grown into the bladder muscle, increasing the risk of spreading and requiring more aggressive treatment. 

What is the difference between stage and grade? 

Stage describes how far the cancer has spread, while grade describes how abnormal and aggressive the cancer cells appear. 

Can low-grade bladder cancer become high-grade? 

Some low-grade tumors can come back and progress to high-grade disease, but this is rare.

Medically reviewed by: Taylor Goodstein, MD, Assistant Professor of Clinical Urology
Last medically reviewed: September 14, 2026

Resources 

TURBT procedure  

Bladder cancer survival rates