Bladder Cancer: TNM Staging

Clinical vs. Pathological Staging[edit | edit source]

Based on
1. Histologic findings at transurethral resection of bladder tumor (TURBT)
2. Clinician's physical exam, including bimanual exam under anesthesia
3. Findings on radiologic imaging

Also known as surgical staging
Based on the extent of disease following surgical resection of the bladder (partial or radical cystectomy) and of the adjacent pelvic lymph nodes

pTX: tumour cannot be assessed
pT0: no evidence of tumour
pTa: non-invasive (confined to epithelial mucosa) papillary carcinoma
pTis: carcinoma in-situ
pT1: invades lamina propria (subepithelial connective tissue)
- Subdivision into pT1a vs. pT1b has been proposed with some studies suggesting that deep lamina propria invasion carries a substantially more serious prognosis. However, the value of substaging has not been validated in other studies
pT2
- pT2a: invades superficial muscularis propria
- pT2b: invades deep muscularis propria
pT3
- pT3a: invades perivesical fat microscopically
- pT3b: invades perivesical fat macroscopically
pT4
- pT4a: invades prostatic stroma, seminal vesicles, uterus, or vagina
  - Extension of the tumor into the prostatic urethra WITHOUT stromal invasion is currently classified under the prostatic urethral cancer staging and does not carry an adverse prognosis for patients with known bladder cancer
- pT4b: invades pelvic/abdominal wall
Prognostic value of T2 and T3 substaging has been widely debated and reported

Nx: lymph nodes cannot be assessed
N0: no lymph node metastasis
N1: single regional lymph node in the true pelvis
- True pelvis lymph nodes (5)
  1. Perivesical
  2. Obturator
  3. Internal iliac (hypogastric)
  4. External iliac
  5. Presacral lymph nodes
N2: multiple regional lymph node metastases in the true pelvic
N3: lymph node metastasis to the common iliac lymph nodes

Pathologically, organ-confined bladder cancer is considered to be pT2bN0M0 or less at the time of cystectomy