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Bladder Cancer Treatment (PDQ®)

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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 following:

  • Size and mobility of palpable masses.
  • Degree of induration of the bladder wall.
  • Presence of extravesical extension or invasion of adjacent organs.

Clinical staging, even when computed tomographic (CT) and/or magnetic resonance imaging (MRI) scans and other imaging modalities are used, often underestimates the extent of tumor, particularly in cancers that are less differentiated and more deeply invasive. CT imaging is the standard staging modality. A clinical benefit from obtaining MRI or positron emission tomography scans rather than CT imaging has not been demonstrated.[1,2]

AJCC Stage Groupings and TNM Definitions

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define bladder cancer.[3]

Table 1. Definitions of TNM Stages 0 and 0is
StageTNMDescriptionIllustration
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.
0aTa, N0, M0Ta = Noninvasive papillary carcinoma.
Stage 0 bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. First inset shows papillary carcinoma on the inner lining of the bladder. Second inset shows carcinoma in situ on the inner lining of the bladder. Also shown are the layers of connective tissue and muscle tissue of the bladder and the layer of fat around the bladder.
N0 = No lymph node metastasis.
M0 = No distant metastasis.
0isTis, N0, M0Tis = Carcinoma in situ: "flat tumor."
N0 = No lymph node metastasis.
M0 = No distant metastasis.
Table 2. Definition of TNM Stage I
StageTNMDescriptionIllustration
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.
IT1, N0, M0T1 = Tumor invades subepithelial connective tissue.
Stage I bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder and in the layer of connective tissue next to it. Also shown are the muscle layers of the bladder and the layer of fat around the bladder.
N0 = No lymph node metastasis.
M0 = No distant metastasis.
Table 3. Definition of TNM Stage II
StageTNMDescriptionIllustration
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.
IIT2a, N0, M0T2a = Tumor invades superficial muscularis propria (inner half).
Stage II bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder, the layer of connective tissue, and the muscle layers. Also shown is the layer of fat around the bladder.
N0 = No lymph node metastasis.
M0 = No distant metastasis.
T2b, N0, M0T2b = Tumor invades deep muscularis propria (outer half).
N0 = No lymph node metastasis.
M0 = No distant metastasis.
Table 4. Definition of TNM Stage III
StageTNMDescriptionIllustration
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.
IIIT3a, N0, M0T3a = Tumor invades perivesical tissue microscopically.
Stage III bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder, the layer of connective tissue, the muscle layers, and the layer of fat around the bladder.
N0 = No lymph node metastasis.
M0 = No distant metastasis.
T3b, N0, M0T3b = Tumor invades perivesical tissue macroscopically (extravesical mass).
N0 = No lymph node metastasis.
M0 = No distant metastasis.
T4a, N0, M0T4a = Tumor invades prostatic stroma, uterus, vagina.
N0 = No lymph node metastasis.
M0 = No distant metastasis.
Table 5. Definition of TNM Stage IV
StageTNMDescriptionIllustration
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.
IVT4b, N0, M0T4b = Tumor invades pelvic wall, abdominal wall.
Stage IV bladder cancer; drawing shows cancer in the bladder, the pelvic wall, and lymph nodes. Inset shows some other parts of the body where cancer can spread from the bladder: the lung, liver, and bone.
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.
Table 6. WHO/ISUP Recommended Grading System
WHO = World Health Organization; ISUP = International Society of Urologic Pathology.
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, p 497.
GXGrade cannot be assessed.
G1Well differentiated.
G2Moderately differentiated.
G3Poorly differentiated.
G4Undifferentiated.

References

  1. Cowan NC, Crew JP: Imaging bladder cancer. Curr Opin Urol 20 (5): 409-13, 2010. [PUBMED Abstract]
  2. Green DA, Durand M, Gumpeni N, et al.: Role of magnetic resonance imaging in bladder cancer: current status and emerging techniques. BJU Int 110 (10): 1463-70, 2012. [PUBMED Abstract]
  3. 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.
  • Updated: October 23, 2014