How is bladder cancer staged?

Updated: Apr 03, 2019
  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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The American Joint Committee has designated staging based on the tumor, node, and metastases (TNM) classification.

  • The TNM system for the primary tumor (T) is as follows:

    • Stage TX - Primary tumor cannot be assessed

    • Stage T0 - No evidence of primary tumor

    • Stage Ta - Noninvasive papillary carcinoma

    • Stage Tis - Carcinoma in situ

    • Stage T1 - Invades subepithelial connective tissue

    • Stage T2a - Invades superficial muscle (inner half)

    • Stage T2b - Invades deep muscle (outer half)

    • Stage T3a - Microscopic invasion of perivesical tissue

    • Stage T3b - Macroscopic invasion of perivesical tissue

    • Stage T4a - Invades stroma of the prostate, uterus, and/or vagina

    • Stage T4b - Invades pelvic sidewall or abdominal wall

  • The following is the TNM system for the regional lymph nodes (N). Note that regional lymph nodes are in the pelvis; all others are considered distant lymph nodes.

    • Stage NX - Regional lymph nodes cannot be assessed

    • Stage N0 - No regional lymph node metastasis

    • Stage N1 - Metastasis to a single lymph node in the true pelvis

    • Stage N2 - Metastasis to 2 or more lymph nodes in the true pelvis

    • Stage N3 - Metastasis to lymph nodes that lie along the common iliac artery

  • The TNM system for distant metastasis (M) is as follows:

    • Stage MX - Distant metastasis cannot be assessed

    • Stage M0 - No distant metastasis

    • Stage M1 - Metastasis to distant lymph nodes, organs or tissues (i.e. bones. lungs or liver)

While overstaging is relatively uncommon, clinical understaging occurs in as many as 53% of patients.

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