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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 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.[1,2,3]

    Definitions of TNM

    The American Joint Committee on Cancer has designated staging by TNM classification to define bladder cancer.[4]

    Table 1. Primary Tumor (T)a

    a 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.
    TXPrimary tumor cannot be assessed.
    T0No evidence of primary tumor.
    TaNoninvasive papillary carcinoma.
    TisCarcinomain situ: "flat tumor."
    T1Tumor invades subepithelial connective tissue.
    T2Tumor invades muscularis propria.
    pT2aTumor invades superficial muscularis propria (inner half).
    pT2bTumor invades deep muscularis propria (outer half).
    T3Tumor invades perivesical tissue.
    pT3aMicroscopically.
    pT3bMacroscopically (extravesical mass).
    T4Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall.
    T4aTumor invades prostatic stroma, uterus, vagina.
    T4bTumor invades pelvic wall, abdominal wall.

    Table 2. Regional Lymph Nodes (N)a,b

    a 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.
    b Regional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes.
    NXLymph nodes cannot be assessed.
    N0No lymph node metastasis.
    N1Single regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node).
    N2Multiple regional lymph node metastases in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node).
    N3Lymph node metastases to the common iliac lymph nodes.
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