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Bladder Cancer Treatment (PDQ®)

  • Updated: 07/11/2014

Table 5. Definition of TNM Stage IV

Stage  TNM Description Illustration 
IVT4b, N0, M0T4b = Tumor invades pelvic wall, abdominal wall.
N0 = No lymph node metastasis.
M0 = No distant metastasis.
Any T, N1–N3, M0TX = 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 = Tumor invades perivesical tissue microscopically.
pT3b = Tumor invades perivesical tissue 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.
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.
M0 = No distant metastasis.
Any T, any N, M1TX = 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 = Tumor invades perivesical tissue microscopically.
pT3b = Tumor invades perivesical tissue 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.
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.
M1 = Distant metastasis.

T = primary tumor; N = regional lymph nodes; M = distant metastasis.
Reprinted 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.