Bladder cancer staging helps your doctor plan your treatment. It also gives your doctor an idea of how successful treatment is likely to be. Your doctor will use imaging tests, such as CT scans and MRIs to determine the exact location of the tumor and whether or not the cancer has spread beyond the bladder. In planning an overall course of treatment, doctors also rely on pathology results from a sample, or biopsy of the tumor. The biopsy will occur either before or during surgery to remove the tumor. The pathology report provides specific details on the cancer cells that helps estimate how the tumor is likely to respond to certain treatments. The stage of bladder cancer will depend on the following factors: How deep the tumor is in the wall of your bladder Whether cancer cells are in your lymph nodes Whether the cancer has spread (metastasized) to other organs There are five stages of bladder cancer: 0, I, II, III and IV. Higher numbers indicate more advanced disease. Lower stages tend to respond better to treatment and have a better outlook. Stage 0 Stage 0 is the earliest form of bladder cancer. The tumor is only in the bladder lining and is usually easy to remove. If your doctor can remove the entire tumor, this may be the only treatment you need. An alternative treatment at this stage is intravesical therapy. This involves administering either chemotherapy or immunotherapy directly into the bladder. Stage I Stage I is still an early form of bladder cancer. However, the tumor has broken through the bladder lining and is growing into adjacent tissues. Treatment is similar to stage 0. In most cases, doctors recommend surgery to remove the tumor and intravesical therapy afterwards. Aggressive stage I bladder cancer may require removal of part or all of the bladder. Stage II Stage II bladder cancer has spread deeper into the bladder wall, invading the muscle layer. It still remains confined to the bladder and has not spread to lymph nodes or other areas. At this stage, it is necessary to remove the bladder. Systemic chemotherapy either before or after surgery is standard treatment. In some cases, doctors may recommend removing only part of the bladder, with radiation therapy and chemotherapy afterwards. Stage III In stage III bladder cancer, the tumor has grown through the bladder wall. It may have also spread to the reproductive organs, such as the prostate gland in men and the ovaries or uterus in women. However, it has not grown into the abdominal wall, lymph nodes, or distant body sites. Treatment involves surgery to remove the bladder with chemotherapy beforehand to shrink the tumor. Chemotherapy may also be necessary after bladder cancer surgery. For people who can’t have surgery, doctors typically recommend treatment with both radiation therapy and chemotherapy. Stage IV Stage IV is advanced bladder cancer. It has spread to the abdominal wall, nearby lymph nodes, or distant body sites. At this stage, it is usually not possible to remove all the cancer with surgery. However, surgery may still be part of the treatment plan. Doctors also use chemotherapy with or without radiation treatment to control tumor growth as much as possible, and to relieve symptoms. Immunotherapy and targeted anticancer drugs may also be an option for stage IV bladder cancer. In early tests, these drugs inhibit the growth of advanced bladder tumors and shrink them in some cases. More therapies that are currently effective in treating other advanced cancers are now being studied with bladder cancer. Experts are also testing new targeted therapies in bladder cancer clinical trials. An important part of bladder cancer staging and treatment planning is a thoughtful discussion with your doctor and cancer care team. Talk with your care team about the different options and possible outcomes, and what makes the most sense for you personally.