Transitional cell carcinoma of the bladder (staging)

Transitional cell carcinoma of the bladder staging uses the TNM system which has replaced the previously widely used Jewett-Strong-Marshall tumor staging system. It is very similar to the staging of TCC of the renal pelvis and staging of TCC of the ureter.

TNM staging (8^th edition)

T

• Ta: non-invasive papillary tumor

• 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, seminal vesicles, uterus, vaginal vault

  • T4b: pelvic side wall and/or abdominal wall

N

• N0: no nodal involvement

• N1: single node in the true pelvis (hypogastric, obturator, external iliac or presacral nodes)

• N2: multiple nodes in the true pelvis

• N3: metastasis in a common iliac node

M

• M0: no metastases

• M1a: non-regional lymph node involvement

• M1b: other distant metastasis

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

  • Any T, N1-3, any M