Radiation Oncology/Bladder/Staging

Bladder Cancer Staging

AJCC 7th Edition (2009)

Primary Tumor:

• Ta - non-invasive papillary carcinoma
• Tis - carcinoma in situ, "flat tumor"
• T1 - invades subepithelial connective tissue
• T2 - invades muscularis propria
  • T2a - invades superficial muscle (inner half)
  • T2b - invades deep muscle (outer half)
• T3 - invades perivesical tissue
  • T3a - microscopically
  • T3b - macroscopically (extravesical mass)
• T4 - invades other organs
  • T4a - invades prostatic stroma, uterus, vagina
  • T4b - invades pelvic wall, abdominal wall

Regional Lymph Nodes:

Regional nodes include (primary nodal drainage): hypogastric, obturator, iliac (int/ext), perivesical, sacral, presacral

Regional nodes (secondary nodal drainage): common iliac

• N0 - none
• N1 - single LN metastasis in the true pelvis (below common iliac)
• N2 - multiple LN metastases in the true pelvis (below common iliac)
• N3 - metastases to the common iliac LNs

Stage Grouping:

• Stage 0a - Ta N0M0
• Stage 0is - Tis N0M0
• Stage I - T1 N0
• Stage II - T2 N0
• Stage III - T3N0 or T4aN0
• Stage IV - T4b or any N+ or M1

Changes from 6th Edition:

• For T4 via prostate invasion, must invade prostate stroma. Subepithelial invasion of the prostatic urethra is not sufficient to qualify for T4.
• N-stages reclassified

Older staging systems

AJCC 6th Edition (2002)
Primary Tumor:

• Ta - non-invasive papillary carcinoma
• Tis - carcinoma in situ, "flat tumor"
• T1 - invades subepithelial connective tissue
• T2 - invades muscle
  • T2a - invades superficial muscle (inner half)
  • T2b - invades deep muscle (outer half)
• T3 - invades perivesical tissue
  • T3a - microscopically
  • T3b - macroscopically (extravesical mass)
• T4 - invades other organs
  • T4a - invades prostate, uterus, vagina
  • T4b - invades pelvic wall, abdominal wall

Regional Lymph Nodes:

Regional nodes are the nodes of the true pelvis below the common iliac.

• N1 - single LN, 2 cm or less
• N2 - single LN 2-5 cm; or multiple LN < 5 cm
• N3 - LN > 5 cm

Stage Grouping:

• Stage 0a - Ta N0M0
• Stage 0is - Tis N0M0
• Stage I - T1 N0
• Stage II - T2 N0
• Stage III - T3N0 or T4aN0
• Stage IV - T4b or any N+ or M1

AJCC 5th Edition (1997)
No changes compared to 6th Edition

AJCC 4th edition (1992)

• T1 (same), T2 (superficial muscle), T3a (deep muscle), T3b (perivesical fat), T4 (invades prostate, uterus, vagina, pelvic wall, abdominal wall)

UICC Staging: 3rd Edition (1978)

• 3rd edition (1978) - T3 is deep muscle invasion (similar to T2b)