Bladder cancer is divided into different stages based on how far the cancer has spread. Stage 2 bladder cancer means that the tumor has started to spread to the muscle layer of the bladder, but it hasn’t spread to other parts of the body. From this stage on, bladder cancer is also called muscle invasive bladder cancer (MIBC).

Knowing your bladder cancer stage helps doctors recommend the best treatment options for you and predict your prognosis (outcome). In this article, we’ll review what it means to have stage 2 bladder cancer, the symptoms you may experience, and what your outlook might be.

How Is Bladder Cancer Staged?

Your cancer care team will use several tests to figure out the stage of your bladder cancer.

Cystoscopy and transurethral resection of bladder tumor (TURBT) are procedures that let your health care provider look at the tumors inside your bladder and take a tissue sample (biopsy).

A bladder tissue sample can help doctors see how deep into the bladder wall the cancer has spread. Looking at the bladder tissue sample under a microscope can also help show how much the cancer cells look like normal cells, which is known as the grade of the cancer. Tissue removed during bladder cancer surgery can give more accurate information about the stage.

Imaging tests make a picture of the inside of your body. These tests can help your doctor see if the cancer has spread to other parts of the body.

Your cancer care team can use all the information from these tests to determine the stage of your cancer using a staging system.

Bladder Cancer Staging System

The TNM system is the most common staging system used for bladder cancer (and many other types of cancer). Each letter in the system stands for a piece of information that helps doctors determine the stage of the cancer:

• T stands for tumor. It shows how deep the cancer has spread into the bladder wall and nearby tissues.
• N stands for lymph nodes. It indicates whether or not cancer has spread to nearby lymph nodes.
• M stands for metastasized. It represents whether the cancer has spread to other parts of the body.

There are five stages of bladder cancer, from stage 0 to stage 4. In general, the higher the stage, the more the cancer has spread. Your stage may also include extra letters to describe certain details about the cancer. Earlier letters represent less advanced cancer.

Bladder Cancer Grading System

In addition to the cancer stage, your cancer care team may also grade your tumor cells. The tumor grade refers to how cancer cells look under the microscope.

Low-grade tumors look more like normal cells and are usually slow-growing and less likely to spread. High-grade tumor cells look very different from normal cells and are more likely to spread and come back after treatment.

Doctors use your tumor grade to help predict how fast your cancer might grow and spread.

What Is Stage 2 Bladder Cancer?

In stage 2 bladder cancer, the tumor has grown into the muscle layer of the bladder but hasn’t gone beyond that. In the TNM system, stage 2 bladder cancer is described as T2a or T2b, N0, M0.

• T2a means the cancer has spread to the inner layer of muscle.
• T2b means the cancer has spread to the outer muscle layer.
• N0 means the cancer has not spread to nearby lymph nodes.
• M0 means the cancer hasn’t metastasized.

What Are the Symptoms of Stage 2 Bladder Cancer?

In stage 2 bladder cancer, symptoms may include:

• Blood in the urine (known as hematuria)
• Frequent urination
• Urgent urination
• Painful urination

Because the cancer hasn’t spread to other parts of your urinary tract or distant organs, you’re less likely to have symptoms of advanced bladder cancer. These advanced symptoms may include lower back pain, weakness, or being unable to urinate.

It can be tricky to diagnose stage 2 bladder cancer based on your symptoms alone because other conditions can cause similar symptoms. For example, urinary tract infections (UTIs), an enlarged prostate, and kidney or bladder stones can all lead to symptoms that are similar to those of bladder cancer.

How Is Stage 2 Bladder Cancer Treated?

While bladder cancer treatment options are mainly based on the cancer stage, your cancer care team will also consider several other factors, including:

• The type of bladder cancer you have
• The grade of your cancer
• The size of the tumor
• The number of tumors you have
• Your overall health
• Your personal preferences

If you’ve been diagnosed with stage 2 bladder cancer, you may have several treatment options. Let’s take a look at some of the most common ones.

Neoadjuvant Therapy Followed by Surgery

Neoadjuvant therapy is a treatment given before surgery to shrink the tumor. The most common type of neoadjuvant therapy for stage 2 bladder cancer is chemotherapy with cisplatin (Platinol) combined with other chemotherapy drugs. Getting chemotherapy before surgery helps shrink the tumor to make it easier to remove with surgery. It also helps kill any cancer cells that haven’t yet been detected, which may prevent cancer from recurring (coming back) after treatment.

Research shows that people treated with chemotherapy before surgery had a better survival rate than people who only had surgery. However, surgery alone can be an option for people who can’t get cisplatin.

Surgery for stage 2 bladder cancer may involve a partial cystectomy (removing part of the bladder) or a radical cystectomy (removing the entire bladder).

Adjuvant Therapy After Surgery

Adjuvant therapy is treatment given after the primary treatment. If your cancer has a high risk of recurrence, your cancer care team may recommend adjuvant therapy. If you didn’t get chemotherapy before surgery, it may be part of your adjuvant therapy.

Another option for adjuvant therapy is the immunotherapy drug nivolumab (Opdivo). When given after surgery, nivolumab can help significantly increase the time you live without the cancer returning.

Trimodality Therapy

Trimodality therapy may be a treatment option for people who can’t have surgery or would prefer not to have it. The treatments involved in trimodality therapy include:

• TURBT
• Chemotherapy
• Radiation therapy

Research has found that the survival rate for people treated with trimodality therapy is about the same as for people who have a radical cystectomy. However, people who don’t have their bladder removed will need frequent follow-ups to check for recurrence.

Radiation Therapy as Primary Treatment

People who can’t have surgery or chemotherapy may have radiation therapy alone as their primary treatment. However, this option may not be as effective as other treatment options.

What Is the Prognosis for Stage 2 Bladder Cancer?

The National Cancer Institute (NCI) provides statistics for the survival rate of people with bladder cancer. Survival statistics are grouped based on how far bladder cancer has spread instead of by stage.

For localized bladder cancer, there aren’t any signs that cancer has spread outside of the bladder. Stage 2 bladder cancer is considered a localized cancer because cancer is only found in the bladder.

It’s estimated that 71 percent of people with localized bladder cancer will live at least five years after their diagnosis (a five-year relative survival rate). There’s about a 50 percent chance that bladder cancer will come back in people with stage 2 bladder cancer.

The prognosis for people with stage 2 bladder cancer is better than for people with bladder cancer that’s spread to nearby (local or regional spread) or distant parts of the body (metastatic bladder cancer). The five-year relative survival rate for people with regional bladder cancer is 39 percent. The five-year relative survival rate for people with distant bladder cancer is much lower, at 8 percent.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you or a loved one been diagnosed with stage 2 bladder cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.