TNM and staging of Urinary Bladder Cancer Simplified

As discussed earlier in – TNM Classification and Cancer Staging Simplified, Urinary bladder is a hollow organ whose “T” classification resembles that of the gastrointestinal tract. Since, the regional lymph nodes of the urinary bladder also lie beyond the serosa like in colon and rectum, positive regional nodes are usually seen only with advanced tumors, i.e. T4=N1.  The regional lymph nodes are below the bifurcation of the common iliac arteries and above the inguinal ligament

TNM Classification

urinary bladder cancer tnm

Primary Tumor (T)

Progressive involvement of the layers of wall and beyond.

  • T1: Submucosa (Lamina propria or Subepithelial tissue)
  • T2: Muscularis propria
    • a: superficial (inner half)
    • b: deep (outer half)
  • T3: Perivesical fat or tissue
    • a: microscopically
    • b: macroscopically
  • T4: Invasion of adjacent structures
    • a: prostatic stroma, uterus, vagina
    • b: pelvic wall, abdominal wall

Regional Lymph Node (N)

  • N1: Single positive node in primary drainage regions (in true pelvis)
  • N2: Multiple positive nodes in primary drainage regions (in true pelvis)
  • N3: Common iliac nodes

AJCC staging for Bladder Cancer

urinary bladder cancer staging matrix

T4b or N1-3 or M1 = Stage IV (~5% five year survival)

Stage I-III is N0M0 and corresponds to “T” classification:

  • T1N0M0 = Stage I (~88% five year survival)
  • T2N0M0 = Stage II (~63% five year survival)
  • T3 or 4a NoMo = Stage III (~46% five year survival)

General Principle of Management

  • Stage I: Conservatively resected transurethrally
  • Stage II: Partial cystectomies
  • Stage III: Total cystectomy and urethral diversion
  • Stage IV: No longer completely resectable.

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