Guidelines

Muscle-invasive and Metastatic Bladder Cancer

4. STAGING AND CLASSIFICATION SYSTEMS

4.1. Pathological staging

For staging, the Tumour, Node, Metastasis (TNM) Classification (2017, 8th edition) is recommended [75]. Blood and lymphatic vessel invasion have an independent prognostic significance [76,77].

4.2. Tumour, node, metastasis classification

The TNM classification of malignant tumours is the method most widely used to classify the extent of cancer spread [75] (Table 4.1).

Table 4.1: TNM Classification of urinary bladder cancer [75]

T - Primary Tumour

Tx

Primary tumour cannot be assessed

T0

No evidence of primary tumour

Ta

Non-invasive papillary carcinoma

Tis

Carcinoma in situ: “flat tumour”

T1

Tumour invades subepithelial connective tissue

T2

Tumour invades muscle


T2a

Tumour invades superficial muscle (inner half)


T2b

Tumour invades deep muscle (outer half)

T3

Tumour invades perivesical tissue:


T3a

microscopically


T3b

macroscopically (extravesical mass)

T4

Tumour invades any of the following: prostate stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall


T4a

Tumour invades prostate stroma, seminal vesicles, uterus, or vagina


T4b

Tumour invades pelvic wall or abdominal wall

N - Regional Lymph Nodes

Nx

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in a single lymph node in the true pelvis (hypogastric, obturator, external iliac, or presacral)

N2

Metastasis in multiple regional lymph nodes in the true pelvis (hypogastric, obturator, external iliac, or presacral)

N3

Metastasis in a common iliac lymph node(s)

M - Distant Metastasis

M0

No distant metastasis


M1a

Non-regional lymph nodes


M1b

Other distant metastasis

Staging after neoadjuvant chemotherapy (NAC) and RC can be done, but must be mentioned as ypTNM (International Collaboration on Cancer Reporting) [74]. ypT0N0 after NAC and cystectomy is associated with good prognosis [78,79].