Radiation Oncology/Bladder/Staging

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Bladder Cancer Staging


AJCC 7th Edition (2009)[edit]

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[edit]

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)