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-Scott-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

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, 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 <2 cm
• N2
  • single node 2-5 cm or
  • multiple nodes all <5 cm ^2,3
• N3: one or more nodes >5 cm

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