Bladder Cancer Staging

Like with other cancers, for bladder cancer a staging system has also been developed. Although other staging systems have been used in the past, it is now recommended to use the TNM staging developed by the International Union Against Cancer. This was adopted by the American Joint Committee. "T" stands for "tumor", "N" for lymph "node" metastasis and "M" for distant "metastasis". There are subclassifications for each of these categories so that the spread of the cancer can acurately be described.

Here is a brief description of the TNM system for bladder cancer (see table).

Stage of bladder cancer
(TNM classification)	Description of extent of tumor:
Tis	carcinoma in situ (localized in one spot)
T1	invades the tissue layer under the lining of the bladder wall
T2	invades the muscle layer of the bladder, not palpable
T3a	invades deep the muscle layer, it is palpable
T3b	invasion into fat layer around bladder
T4	extension into surrounding organs (prostate or vagina, rectum, bony pelvis or abdominal wall)

This is only a rough overview as it does not show the involvement of lymph nodes and does not list the number of distant metastates. A full report of the TNM classification would contain all of this information. However, for the purposes of this summary it suffices to say that there would not be any lymph node metastases or distant metastases in a Tis or T1 stage.

However, in the T2 stage of bladder cancer it would have spread into 10 or 20 regional lymph glands. There might also be 1 or 2 distant metastases (paraaortic nodes for instance). With a stage T3a there might be 20 lymph nodes affected and 10 distant metastases as well. With theT3b stage there might be 50 positive nodes and 60 more distant metastases, most of them likely in the paraaortic nodes. Sometimes it is difficult to know whether or not a distant metastasis was missed in this stage, as in this case it would be more correctly labeled as T4 stage. This stage is assigned to those cases of bladder cancer where the tumor has eaten its way through the entire bladder wall and spread to one or more neighboring organs or else has metastasized to distant sites such as lungs, brain, bone etc.

We learnt with other cancers that the staging information is important for making predicitions regarding the survival chances (prognosis). I also have pointed out earlier that histology, grade and certain genetic information from the cancer cells are important. All of this information is now put together in an attempt to improve the outlook for the patient (for 5-year survivals click "bladder cancer" below, then "treatment" in the table).

Home page

Cancer overview

Bladder cancer

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997.

2. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr.,et al. J.B. LippincottCo.,Philadelphia,1993.Chapter 34, page 1054 (data from text arranged as a table).

3. M Simoneau et al. Oncogene 2000 Dec 19(54): 6317-6323.

4. G Dalbagni , HW Herr Urol Clin North Am 2000 Feb 27(1): 137-146.

5. HW Herr J Clin Oncol 2001 Jan 1;19(1): 89-93.

6. DA Corral, CJ Logothetis World J Urol 1997; 15(2): 139 - 143.

7. PM Dodd et al. J Clin Oncol 1999 Aug;17 (8): 2546- 2552.

8. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.

Last Modified: Feb. 2, 2012