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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)
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
Tumor invades perivesical tissue.
- T3a: microscopic perivesical infiltration
- T3b: macroscopic perivesical infiltration
Tumor invades adjacent organs.
- T4a: infiltration of prostate, uterus or vagina
- T4b: infiltration of the pelvic or abdominal wall
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).
- M0: no distant metastasis
- M1: distant metastasis
- 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
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%.
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].