Transitional cell carcinoma of the bladder (staging)

Last revised by Daniel J Bell on 13 Dec 2022

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 (8th edition)

  • 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

  • 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

  • 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

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Cases and figures

  • Case 1: T3b
    Drag here to reorder.
  • Case 2: T4a with ureteric and uterine invasion
    Drag here to reorder.
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