Definition of Staging

A staging system indicates if cancer has spread and to what extent. Staging describes the extent or severity of cancer based on the size of the original tumor and the extent it has spread in the body or the affected organ. With bladder cancer, the stage of the cancer refers to the location of the tumor within the bladder or, more specifically, the speed of growth and the tumor’s penetration into the bladder.

While there are different staging systems for bladder cancer, the most widely used system in the United States is called the TNM System. It is also known as the Staging System of the American Joint Committee on Cancer. 1

General Information on Staging

Staging is based on knowledge of how cancer develops. Cancer cells divide and grow to form a mass of tissue called a tumor. As the tumor grows, it can invade nearby organs and tissues. Cancer cells may also break away from the tumor and enter the bloodstream or lymphatic system. By moving through the bloodstream or lymphatic system, cancer can spread from the primary site to form new tumors in other organs. The spread of cancer is called metastasis. 2

Purpose of Staging

Staging helps the cancer diagnosis and treatment process in important ways.

  • Staging helps doctors plan a patient’s appropriate treatment.
  • The stage can be used to estimate the person’s prognosis (likely outcome or course of the disease).
  • Knowing the stage helps to identify clinical trials that may be suitable for a patient. 3

Staging also helps researchers and health care providers exchange information about patients and provide a common language for diagnosis, treatment and clinical trials.

Tests to Determine Bladder Cancer Stage

The following tests and procedures may be used in the staging process:

  • Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples that are checked under a microscope for signs of cancer.
  • CT scan (CAT scan) : A procedure that makes several detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to take several detailed photographs inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Physical exam and history: An exam of the body to check general signs of health, including signs of disease such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making an image of areas in the body.
  • Bone scan: A procedure to check for rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

Staging Bladder Cancer

Your treatment options will depend on the stage of your disease. The following is a description of the various stages of bladder cancer:

Stage 0 – In this stage, abnormal cells are found in tissue that lines the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of tumor. Stage 0a is also called papillary carcinoma and may look like tiny mushrooms growing from the lining of the bladder. Stage 0 is also called carcinoma in situ and is a flat tumor on the tissue lining the inside of the bladder.

Stage I – In stage I, cancer has formed and spread to the layer of tissue under the inner lining of the bladder.

Stage II – In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III – In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).

Stage IV – In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

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