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Bladder Cancer Stages and Grades Explained

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Published on May 14, 2021

What Are the Stages and Grades of Bladder Cancer?

It is important to have a thorough understanding of your bladder cancer diagnosis, which includes the grade and stage of the cancer. Follow along as Dr. Stephen Riggs, MD, Associate Professor in the Division of Urology at Levine Cancer Institute, explains the different stages and grades used to assess bladder cancer and how this information impacts treatment choice, the urgency of treatment, and overall outcome.

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Transcript | Bladder Cancer Stages and Grades Explained

What Are the Different Stages and Grades of Bladder Cancer?

Dr. Riggs: So in bladder cancer, well, I think of it, staging and grading are great ways to think about it. And under the grading, it really comes in two forms. What a lot of patients will hear about is low grade versus high grade. High grade traditionally means to us as clinicians, the more concerning cancer. Doesn't mean it's guaranteed to be life-threatening, but the more concerning, the one we have to treat a little bit more aggressively. And then I tell people the low grade is often, that's the more favorable type of bladder cancer. There’s not many people that die of low-grade bladder cancer, if ever. And so that's a big distinction. And then the stage. The stage, really, is hard for patients to kind of put in perspective. I really talk to people about muscle invasion versus non-muscle invasion. And that's the way we think about bladder cancer.

So, it's either deep into the muscle or short of the muscle. So non-muscle invasion, short of the muscle, into the muscle, is muscle invasion. And the reason that is important is because that really starts to separate the treatment modality. So, you're really in one of two buckets, you're either low grade or high grade. All high grade is, you cannot be muscle-invasive without high grade. You can be non-muscle — in non-muscle-invasive, you could be low grade or high grade. And so that's the way we think about it. There is staging: stage one, two, three, four. Stage one is all non-muscle invasive. Stage two, so think of the second layer into the muscle, and then three goes beyond the muscle. And then when you talk about stage four in bladder cancer, analogous to a lot of other cancers, you're talking about disease outside the bladder, beyond the bladder, we call that metastasis.

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