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Cancer Staging Systems

Staging of bladder cancer

TNM definition

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Ta: Noninvasive papillary carcinoma
• Tis: Carcinoma in situ: “flat tumor”
• T1: Tumor invades subepithelial connective tissue
• T2: Tumor invades muscle
  • pT2a: Tumor invades superficial muscle (inner half)
  • pT2b: Tumor invades deep muscle (outer half)
• T3: Tumor invades perivesical tissue
  • pT3a: Microscopically
  • pT3b: Macroscopically (extravesical mass)
• T4: Tumor invades any of the following: prostate, uterus, vagina, pelvic wall, or abdominal wall
  • T4a: Tumor invades the prostate, uterus, vagina
  • T4b: Tumor invades the pelvic wall, abdominal wall

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in a single lymph node, 2 cm or less in greatest dimension
• N2: Metastasis in a single lymph node, more than 2 cm but not more than 5 cm in greatest dimension; or multiple lymph nodes, none more than 5 cm in greatest dimension
• N3: Metastasis in a lymph node, more than 5 cm in greatest dimension

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

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Stage grouping

Stage 0a

• Ta, N0, M0

Stage 0is

• Tis, N0, M0

Stage I

• T1, N0, M0

Stage II

• T2a, N0, M0
• T2b, N0, M0

Stage III

• T3a, N0, M0
• T3b, N0, M0
• T4a, N0, M0

Stage IV

• T4b, N0, M0
• Any T, N1, M0
• Any T, N2, M0
• Any T, N3, M0
• Any T, any N, M1

References

1. Urinary bladder. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 335-340. 

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