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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].