Staging of transitional cell carcinoma of the bladder

Transitional cell carcinoma of the bladder is staged using the TNM system (which has replaced the previously widely used Jewett-Scott-Marshall tumour staging system. It is very similar to staging of TCC of the renal pelvis and to staging of TCC of the ureter.

TNM staging

T

• Ta - non invasive papillary tumour
• Tis - in situ (non invasive flat)
• T1 - through lamina propria into sub-epithelial connective tissues
• T2 - into muscularis propria
  • T2a - only invades inner half of the muscle
  • T2b - invades into outer half of the muscle
• T3 - invasion into perivesical tissues
  • T3a - microscopic extravesical invasion
  • T3b - macroscopic extravesical invasion
• T4 - direct invasion into adjacent structures
  • T4a - prostate, uterus, vaginal vault
  • T4b - pelvic side wall and / or abdominal wall

N

Nodal staging is the same for TCC of any part of the urinary tract.

• N0 - no nodal involvement
• N1 - single node involved < 2cm
• N2
  • single node 2-5cm or
  • multiple nodes all < 5cm ^2-3
• N3 - one or more nodes > 5cm

M

• M0 - no metastases
• M1 - metastases identified

Staging groups

Individual TNM stages can then be grouped ^3-4:

• stage 0 - Ta or Tis, N0, M0
• stage I - T1, N0, M0
  
• stage II - T2(a or b), N0, M0
  
• stage III - T3(a or b) or T4a, N0, M0
• stage IV
  • T4b, any N, any M
  • N1-3, any T, any M