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- Major staging is the AJCC –UICC {TNM} system Table 1
- Staging consists of excisional TUR biopsy with effort to obtain true detrusor muscle. Adjacent or random biopsies may be of value. Biopsy of the prostatic urethra is useful for staging and reconstructive considerations.
- Bimanual exam. Performed under anesthesia during time of TUR . Pelvic fixation implies extravesical disease and limited potential for exenteration.
- Cross sectional imaging CT and MRI. Evaluation of upper tracts for disease or obstruction. Rough estimate of tumor stage[tends to over stage] and evaluation of gross nodal extension and hepatic involvement.
- Accuracy. Clinical staging can be very imprecise with under staging in 30-45% of patients and over staging in 20-50% of patients. A complete evaluation of the cystectomy specimen is necessary for accurate pathological staging
Table 1 Bladder Cancer TNM Staging System 1997
| Primary Tumor (T) |
| TX |
Primary tumor cannot be assessed |
| Ta |
Noninvasive papillary carcinoma |
| Tis |
Carcinoma in situ |
| T1 |
Tumor invades subepithelial connective tissue |
| T2a |
Tumor invades superficial detrusor muscle |
| T2b |
Tumor invades deep detrusor muscle |
| T3a |
Tumor invades perivesical tissue microscopically |
| T3b |
Tumor invades perivesical tissue macroscopically |
| T4a |
Tumor invades prostate, uterus, and vagina |
| T4b |
Tumor invades pelvic wall, abdominal wall |
| Regional Lymph Nodes (N) |
| NX |
Regional lymph nodes cannot be assessed |
| NO |
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 > 2 cm but < 5 cm, or multiple lymph nodes, none > 5 cm |
| N3 |
Metastasis in a lymph node > 5 cm in greatest dimension |
| Distant Metastasis (M) |
| MX |
Distant metastasis cannot be assessed |
| M0 |
No distant metastasis |
| M1 |
Distant metastasis |
| Stage Grouping |
| 0a |
Ta |
N0 |
M0 |
| Ois |
Tis |
N0 |
M0 |
| I |
T1 |
N0 |
M0 |
| II |
T2a |
N0 |
M0 |
| |
T2b |
N0 |
M0 |
| III |
T3a |
N0 |
M0 |
| |
T3b |
N0 |
M0 |
| |
T4a |
N0 |
M0 |
| IV |
T4b |
N0 |
M0 |
| |
Any T |
Any N |
Any M |
References
- Droller MJ: Bladder: Anatomical overview in surgical management of urologic disease: An anatomic approach, MJ Droller, St. Louis, Mosby Yearbook, p 575, 1992.
- Herr HW, Schwalb DM, Zhang ZF, et al: Intravesical bacillus Calmette-Guerin therapy prevents tumor progression and death from superficial bladder cancer: Ten-year follow-up of a prospective randomized trial. J Clin Oncol 13:1404, 1995.
- Lamm DL: Complications of bacillus Calmette-Guerin immunotherapy. Urol Clin North Am 19:565, 1992.
- Malkowicz SB: Superficial bladder cancer: The role of molecular markers in the treatment of high-risk superficial disease. Semin Urol Oncol 15:169-178, 1997.
- Messing EM, Catalona W: Urothelial tumors of the urinary tract. In: Campbell's Urology 7th ed. PC Walsh, AB ED Vaughan, AJ Wein, Vol 3, Chap 77, 2327, 1998.
- Spruck CH, Ohneseit PE, Gonzalez-Zulueta M, et al: Two molecular pathways to transitional cell carcinoma of the bladder. Cancer Res 54:784-788, 1994.
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