Diagnosing bladder cancer

If your doctor suspects you have bladder cancer, they will examine you and arrange tests. The tests you have may include:

• general tests to check your overall health

• tests to find cancer

• further tests to see if the cancer has spread (metastasised).

Some tests may be repeated during and after treatment to see how the treatment is working. If you feel anxious waiting for test results, it may help to talk to a friend or family member, or call Cancer Connect on 13 11 20.

Tests for bladder cancer

My diagnosis was made after the biopsy. I felt relieved to finally have a label for my illness.

Dee

Staging bladder cancer

The staging system most commonly used is the TNM system, which stands for tumour-node-metastasis.

Using this information, the doctor may describe the cancer as:

Superficial bladder cancer – This is also called non-muscle-invasive bladder cancer or NMIBC. The cancer cells are found only in the inner lining of the bladder (urothelium) or the next layer of tissue (lamina propria) and haven’t grown into the deeper layers of the bladder wall. Learn more about superficial bladder cancer treatment.

Muscle-invasive bladder cancer (MIBC) – The cancer has spread through the urothelium and lamina propria into the layer of muscle (muscularis propria), or sometimes through the bladder wall into the surrounding fatty tissue. MIBC can also sometimes spread to lymph nodes close to the bladder. Learn more about muscle-invasive bladder cancer (MIBC) treatment.

Advanced bladder cancer – The cancer has spread (metastasised) outside of the bladder into distant lymph nodes or other organs of the body. Learn more about advanced bladder cancer treatment.

TNM staging system

The most common staging system for bladder cancer is the TNM system. In this system, letters and numbers are used to describe the cancer, with higher numbers indicating larger size or spread.

T stands for tumour – Ta, Tis and T1 are superficial bladder cancer, while T2, T3 and T4 are muscle-invasive bladder cancer.

N stands for nodes – N0 means the cancer has not spread to the lymph nodes; N1, N2 and N3 indicate it has spread to lymph nodes. NX means it is unknown.

M stands for metastasis – M0 means the cancer has not spread to distant parts of the body; M1 means it has spread to distant parts of the body. MX means it is unknown.

Some doctors put the TNM scores together to produce an overall stage, from stage 1 (earliest stage) to stage 4 (most advanced).

Grade and risk category

The biopsy and/or TURBT results will show the grade of the cancer. This is a score that describes how quickly a cancer might grow.

Knowing the grade helps your urologist predict how likely the cancer is to come back (recur) or grow into deeper layers (progress), and if you will need further treatment after surgery.

The grade may be described as:

Low grade – The cancer cells look similar to normal bladder cells and are usually slow-growing. They are less likely to invade and spread.

High grade – The cancer cells look very abnormal and grow quickly; they are more likely to spread both into the bladder muscle and outside the bladder.

In superficial bladder cancers, the grade may be low or high, while almost all muscle-invasive cancers are high grade. Carcinoma in situ (stage Tis in the TNM system) is a flat, high-grade tumour that needs to be treated quickly to prevent it invading the muscle layer.

Risk category – Based on the stage, grade and other features, a superficial bladder cancer will also be classified as having a lower or higher risk of returning after treatment or spreading into the muscle layer. Knowing the risk category will help your doctors work out which treatments to recommend.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.

In general, the earlier bladder cancer is diagnosed, the better the outcome. To work out your prognosis, your doctor will consider:

• your test results
• the type of bladder cancer
• the stage, grade and risk category
• how well you respond to treatment
• other factors such as your age, fitness and medical history.