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

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