Radiation Oncology/Bladder/Staging

Bladder Cancer Staging

AJCC 7th Edition (2009)
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
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)