Last Modified: 02/08/2013
Stage Information for Bladder Cancer
The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall by the tumor. This determination requires a cystoscopic examination that includes a biopsy, and examination under anesthesia to assess the size and mobility of palpable masses, the degree of induration of the bladder wall, and the presence of extravesical extension or invasion of adjacent organs. Clinical staging, even when computed tomographic and/or magnetic resonance imaging scans and other imaging modalities are used, often underestimates the extent of tumor, particularly in cancers that are less differentiated and more deeply invasive.[1-3]
Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define bladder cancer.[4]
Table 1. Primary Tumor (T)a| aReprinted with permission from AJCC: Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497–505. | |
| TX | Primary tumor cannot be assessed. |
| T0 | No evidence of primary tumor. |
| Ta | Noninvasive papillary carcinoma. |
| Tis | Carcinoma in situ: "flat tumor." |
| T1 | Tumor invades subepithelial connective tissue. |
| T2 | Tumor invades muscularis propria. |
| pT2a | Tumor invades superficial muscularis propria (inner half). |
| pT2b | Tumor invades deep muscularis propria (outer half). |
| T3 | Tumor invades perivesical tissue. |
| pT3a | Microscopically. |
| pT3b | Macroscopically (extravesical mass). |
| T4 | Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall. |
| T4a | Tumor invades prostatic stroma, uterus, vagina. |
| T4b | Tumor invades pelvic wall, abdominal wall. |
Table 2. Regional Lymph Nodes (N)a,b
| NX | Lymph nodes cannot be assessed. |
| N0 | No lymph node metastasis. |
| N1 | Single regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node). |
| N2 | Multiple regional lymph node metastases in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node). |
| N3 | Lymph node metastases to the common iliac lymph nodes. |
| aReprinted with permission from AJCC: Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497–505. | |
| bRegional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes. |
Table 3. Distant Metastasis (M)a
| aReprinted with permission from AJCC: Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497–505. | |
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
Table 4. Anatomic Stage/Prognostic Groupsa
| Stage | T | N | M |
| aReprinted with permission from AJCC: Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497–505. | |||
| 0a | Ta | N0 | M0 |
| 0is | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| II | T2a | N0 | M0 |
| T2b | N0 | M0 | |
| III | T3a | N0 | M0 |
| T3b | N0 | M0 | |
| T4a | N0 | M0 | |
| IV | T4b | N0 | M0 |
| Any T | N1–3 | M0 | |
| Any T | Any N | M1 | |
An older, less frequently used staging system was derived by comparing clinical estimates of stage with the pathologic stage of radical cystectomy specimens.[2,3] To better ensure uniform staging and reporting of clinical results, the use of the modern TNM classification described above is recommended.
References- Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988. [PUBMED Abstract]
- Marshall VF: The relationship of the preoperative estimate to the pathologic demonstration of the extent of vesical neoplasms. J Urol 68(4): 714-723, 1952.
- Skinner DG: Current state of classification and staging of bladder cancer. Cancer Res 37 (8 Pt 2): 2838-42, 1977. [PUBMED Abstract]
- Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497-505.