Definitive diagnosis of bladder cancer requires surgery to obtain the bladder tissue for the pathologists. The surgeon will also assess the stage of the tumor i.e. how far the disease has spread. The stage of the tumor is the most important indicator of prognosis and overall survival for invasive tumors.

Staging is an assessment of how far the tumor has spread.

  • Stage 1: The tumor has spread only into loose tissue beneath the lining (lamina propria) but not into the bladder's muscular wall or beyond. No lymph nodes are involved.

  • Stage 2: Tumor has invaded into the muscle wall (muscularis propria) of the bladder but has not spread to lymph nodes or other sites in the body.

  • Stage 3: Tumor has invaded through the muscle wall (muscularis propria) of the bladder to involve the soft tissue around the bladder OR has invaded adjacent organs including the prostate, uterus or vagina. No lymph nodes or other distant sites in the body are involved at this stage.

  • Stage 4: Tumor has extended out of the bladder to invade the pelvic or abdominal wall, but does not involve lymph nodes or other distant sites in the body. OR Tumor has spread to involve lymph nodes and/or other distant sites in the body

In general, the lower the stage of the tumor, the better the prognosis.

Recurrent & Refractory

Recurrence means that the tumor has returned after initial therapy. Refractory means that the tumor fails to respond to initial treatment.


Doctors also describe bladder cancer by its grade (G). The grade describes the extent to which cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and has different cell groupings, it is called "differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor."

Many urologic surgeons classify a tumor’s grade based on the chance that the cancer will recur or grow and spread, called progression. They often plan treatment based on the grade, using the following categories:

  • Low grade: This type of cancer may recur.

  • High grade: This type of cancer is more likely to recur and grow.