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Bladder Cancer Stages And Grade

Grade and Stages

Once the physician has determined that a tumor exists, the next step is to clarify the tumor's status. Several questions will have to be answered:

• Is the tumor large or small?
• Does it lie within the lining of the bladder or has it extended into the surrounding tissue?
• Has the tumor spread to nearby lymph nodes?
• Has the tumor metastasized to distant sites within the body?

Fortunately, a number of systems have been developed to answer these questions. The most common of these — the TNM (tumor, node, metastasis) system — allows tumors to be classified, or "staged," according to their overall characteristics. A biopsy is removed and sent to a histopathologist for examination under a microscope. The pathologist then assigns a stage and a grade to the tissue sample.
The bladder tumor's physical location or, more precisely, the depth of its penetration within the bladder are referred to as the tumor's stage. Tumor stage typically falls into one of two categories:

1. superficial, surface tumors, or
2. invasive, deep-spreading tumors.

Superficial tumors affect only the bladder lining. They grow up and out from the lining tissue and extend into the bladder's hollow cavity. Invasive tumors grow down into the deeper layers of bladder tissue, and they may involve surrounding muscle, fat, and/or nearby organs. Invasive tumors are more dangerous than superficial tumors, since they are more likely to metastasize.

The grade is an estimation of the rate of tumor growth based on microscopic cell characteristics. The majority of methods are based on the level of tumor cell anaplasia, or the loss of cellular "differentiation," or the traits that set a cell apart. Transitional cell carcinomas (TCCs) are classified according to how differentiated their cells are into three classes by the World Health Organization (WHO).

• Grade 1 (well-differentiated)
• Grade 2 (moderately differentiated)
• Grade 3 or Grade 4 (poorly differentiated)

There is a continuing debate about the classification of benign bladder lesions known as papillomas. The WHO defines papilloma as a single papillary (wart-like) growth with 8 or less cell layers in normal-looking surface tissue. By contrast, many pathologists and urologists classify papilloma as a Grade 1 TCC because of its tendency to recur and not to invade muscle.

The tumor stage and tumor grade are highly correlated. In other words, they are Grade 1 tumors with cells that are clearly specialized and well-differentiated. In contrast, practically all muscle-invasive cancers are high grade. grade; that is, they are Grade 3 or 4 tumors, with cells that are nonspecialized and poorly differentiated.More significantly, there is a direct relationship between tumor stage and prognosis (the likelihood that a disease will progress), with superficial tumors having the highest likelihood of a positive outcome..

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