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Bladder cancer (2/7): Tumor Stages and Pathology
Review Literature: EAU guidelines: superficial bladder cancer (Babjuk et al, in 2008 and 2013). Advanced bladder cancer (Stenzl et al, 2009 and Witjes et al, 2013).
Tumor Staging of Bladder Cancer [UICC 2010]
Superficial bladder carcinoma:
- Ta: noninvasive papillary tumor
- Tis: flat high-grade tumor without polarity and without invasion
- T1: Tumor with infiltration of the subepithelial connective tissue (lamina submucosa)
T2:
Tumor invades muscle (tunica muscularis).
- T2a: infiltration of the inner half of the lamina muscularis
- T2b: infiltration of the outer half of the lamina muscularis
T3:
Tumor invades perivesical tissue.
- T3a: microscopic perivesical infiltration
- T3b: macroscopic perivesical infiltration
T4:
Tumor invades adjacent organs.
- T4a: infiltration of prostate, uterus or vagina
- T4b: infiltration of the pelvic or abdominal wall
N:
Lymph node involvement.
- N0: no regional lymph node metastasis
- N1: solitary regional lymph node metastasis (in the true pelvis hypogastric, obturator, external iliac, or presacral).
- N2: multiple regional lymph node metastasis (in the true pelvis hypogastric, obturator, external iliac, or presacral).
- N3: metastases in common iliac lymph node(s).
M:
Distant metastasis.
- M0: no distant metastasis
- M1: distant metastasis
G:
Grading.
- Urotheliale papilloma (completely benign lesion)
- Papillary urothelial neoplasm of low malignant potential (PUNLMP)
- Low grade bladder cancer: corresponding to G1 (well differentiated) and partly to G2 (intermediate differentiated) of the WHO 1973 classification
- High grade bladder cancer: corresponding to partly G2 and G3 (poor to undifferentiated) of the WHO 1973 classification
Macroscopic Pathology of Bladder Cancer
Localization:
Bladder cancer most commonly begins at the side walls or posterior wall in 70%. Less common bladder neck and trigone (20%) or anterior wall in 10%. A multifocal growth can be seen in 50%.
Growth pattern:
The initial growth pattern is either flat and/or exophytic. In advanced disease, the tumor infiltrats the detrusor muscle and adjacent organs [Fig. advanced bladder cancer].