Staging

TNM system classification

Tumor (T) Stage

• Ta lesions: Ta tumors are papillary (exophytic) lesions that tend to recur
• Tis lesions: High-grade intraepithelial neoplasm without invasion into subepithelial connective tissue
• T1 lesions: T1 tumors invade the submucosa or lamina propria
• T2 lesions: Invasion into muscle is present in T2 lesions
  • T2a: Invasion into superficial muscle
  • T2b: Invasion into deep muscle
• T3 lesions: T3 tumors extend beyond muscle into the perivesical fat
  • T3a: Microscopic invasion only
  • T3b: Macroscopic extension or invasion, extravesical mass
• T4 lesions: Tumor invading surrounding structures
  • T4a: Invasion of the prostate, vagina, uterus, or bowel
  • T4b: Invasion of the abdominal or pelvic wall structures or other organs

Lymph Node (N) Stage

• NX: Lymph nodes cannot be assessed
• N0: No lymph node metastasis
• N1: Single regional lymph node metastasis within the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node)
• N2: Multiple regional lymph node metastases within the true pelvis
• N3: Lymph node metastasis spread to the common iliac lymph nodes

Distant Metastasis (M) Stage

• M0: No distant metastasis
• M1: Distant metastasis
  • M1a: Distant metastasis limited to lymph nodes beyond the common iliac arteries
  • M1b: Non-lymph node distant metastases

Simplified staging of Bladder carcinoma

• Stage I: Tumor confined in submucosa or lamina propria.
• Stage II: Tumor invades the muscular layer
• Stage III:
  • Stage IIIA: Invasion of the prostate and may include single regional lymph node metastasis within the true pelvis
  • Stage IIIB: May include Invasion of the prostate and spread to the common iliac lymph nodes
• Stage IV:
  • Stage IVA: Invasion of the abdominal or pelvic wall structures or other organs and Distant metastasis limited to lymph nodes beyond the common iliac arteries.
  • Stage IVB: Non-lymph node distant metastases