Bladder cancer staging

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Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [1] Farima Kahe M.D. [2]

Overview

Bladder cancer may be classified into several subtypes based on TNM system.

TNM Staging

• Stage 0a

TNM	Definition
Ta	Non-invasive papillary urothelial carcinoma
N0	No regional lymph node metastasis
M0	No distant metastasis

• Stage 0is

TNM	Definition
Tis	Non-invasive flat urothelial carcinoma
N0	No regional lymph node metastasis
M0	No distant metastasis

• Stage I

TNM	Definition
T1	The tumor is invasive. It has grown into the lamina propria but has not grown into the muscle of the bladder wall
N0	No regional lymph node metastasis
M0	No distant metastasis

• Stage II

TNM	Definition
T2a	The tumor has grown into the inner half of the muscle of the bladder wall
N0	No regional lymph node metastasis
M0	No distant metastasis

TNM	Definition
T2b	The tumor has grown into the outer half of the muscle of the bladder wall
N0	No regional lymph node metastasis
M0	No distant metastasis

• Stage III

TNM	Definition
T3a	The tumor has grown into the fatty tissue around the bladder but can only be seen through a microscope
N0	No regional lymph node metastasis
M0	No distant metastasis

TNM	Definition
T3b	The tumor has grown into the fatty tissue around the bladder and can be seen on imaging tests or be felt by the surgeon
N0	No regional lymph node metastasis
M0	No distant metastasis

TNM	Definition
T4a	The tumor has grown into the prostate, seminal vesicles, uterus or vagina
N0	No regional lymph node metastasis
M0	No distant metastasis

• Stage IV

TNM	Definition
T4b	The tumor has grown into the pelvic wall or the abdominal wall
N0	No regional lymph node metastasis
M0	No distant metastasis

TNM	Definition
Any T	The tumor may be T1, T2, T3 or T4
N1, N2 or N3	The cancer has spread to regional lymph nodes
M0	No distant metastasis

TNM	Definition
Any T	The tumor may be T1, T2, T3 or T4
Any N	The cancer may have spread to one or more regional lymph nodes
M1	Distant metastasis