TNM Classification for Bladder Cancer

The tumor-node-metastasis (TNM) classification for staging of bladder cancer is provided below.^[1]

Table. TNM Classification for Bladder Cancer (Open Table in a new window)

Primary tumor (T)
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Ta	Noninvasive papillary carcinoma
Tis	Carcinoma in situ: “flat tumor”
T1	Tumor invades lamina propria (subepithelial connective tissue)
T2	Tumor invades muscularis propria
pT2a	Tumor invades superficial muscularis propria (inner half)
pT2b	Tumor invades deep muscularis propria (outer half)
T3	Tumor invades perivesical tissue
pT3a	Microscopically
pT3b	Macroscopically (extravesical mass)
T4	Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall
T4a	Tumor invades prostatic stroma, uterus, vagina
T4b	Tumor invades pelvic wall, abdominal wall
Regional lymph nodes (N)
Regional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes.
NX	Lymph nodes cannot be assessed
N0	No lymph node metastasis
N1	Single regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node)
N2	Multiple regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node metastasis)
N3	Lymph node metastasis to the common iliac lymph nodes
Distant metastasis (M)
MO	No distant metastasis
M1	Distant metastasis
M1a	Distant metastasis limited to lymph nodes beyond the common iliacs
M1b	Non–lymph node distant metastases

Table. Anatomic stage/prognostic groups (Open Table in a new window)

Stage	T	N	M
Stage 0a	Ta	N0	M0
Stage 0is	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2a	N0	M0
Stage II	T2b	N0	M0
Stage IIIA	T3a	N0	M0
	T3b	N0	M0
	T4a	N0	M0
	T1-T4a	N1	M0
Stage IIIB	T1-T4a	N2,N3	M0
Stage IVA	T4b	Any N	M0
Stage IVA	Any T	Any N	M1a
Stage IVB	Any T	Any N	M1b

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Table. TNM Classification for Bladder Cancer

Primary tumor (T)
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Ta	Noninvasive papillary carcinoma
Tis	Carcinoma in situ: “flat tumor”
T1	Tumor invades lamina propria (subepithelial connective tissue)
T2	Tumor invades muscularis propria
pT2a	Tumor invades superficial muscularis propria (inner half)
pT2b	Tumor invades deep muscularis propria (outer half)
T3	Tumor invades perivesical tissue
pT3a	Microscopically
pT3b	Macroscopically (extravesical mass)
T4	Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall
T4a	Tumor invades prostatic stroma, uterus, vagina
T4b	Tumor invades pelvic wall, abdominal wall
Regional lymph nodes (N)
Regional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes.
NX	Lymph nodes cannot be assessed
N0	No lymph node metastasis
N1	Single regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node)
N2	Multiple regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node metastasis)
N3	Lymph node metastasis to the common iliac lymph nodes
Distant metastasis (M)
MO	No distant metastasis
M1	Distant metastasis
M1a	Distant metastasis limited to lymph nodes beyond the common iliacs
M1b	Non–lymph node distant metastases

Table. Anatomic stage/prognostic groups

Stage	T	N	M
Stage 0a	Ta	N0	M0
Stage 0is	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2a	N0	M0
Stage II	T2b	N0	M0
Stage IIIA	T3a	N0	M0
	T3b	N0	M0
	T4a	N0	M0
	T1-T4a	N1	M0
Stage IIIB	T1-T4a	N2,N3	M0
Stage IVA	T4b	Any N	M0
Stage IVA	Any T	Any N	M1a
Stage IVB	Any T	Any N	M1b

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Author

Gary D Steinberg, MD, FACS Professor and Director, Perlmutter Cancer Center, Goldstein Bladder Cancer Program, NYU Langone Health, NYU Urology Associates

Gary D Steinberg, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Society of Clinical Oncology, American Urological Association, International Society of Urology, Society of Laparoscopic and Robotic Surgeons, Society of Urologic Oncology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Heat Biologics; CG Oncology; PhotoCure; Merck; Roche/Genentech; Ciclomed; Taris Biomedical (now Janssen); MDxHealth; Fidia Farmaceuticals; Urogen, Ferring; Aduro; Boston Scientific; Bristol Myers Squibb; Astra Zeneca; Pfizer, Janssen; others<br/>Member of Clinical Trial Protocol Committees for: for: Merck; BMS; Janssen; CG Oncology; Pfizer; PhotoCure; Fidia; Seagen; Protara.

Coauthor(s)

Joel DeCastro, MD, MPH Fellow in Urologic Oncology, Department of Surgery, Section of Urology, University of Chicago Medical Center

Joel DeCastro, MD, MPH is a member of the following medical societies: American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Amit R Patel, MD Fellow in Urologic Oncology, Department of Surgery, Section of Urology, University of Chicago Medical Center

Amit R Patel, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee

Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

E Jason Abel, MD Associate Professor of Urologic Oncology, Department of Urology, Associate Professor of Radiology (Affiliate Appointment), Department of Radiology, University of Wisconsin School of Medicine and Public Health; Attending Urologist, William S Middleton Memorial Veterans Hospital

E Jason Abel, MD is a member of the following medical societies: American Medical Association, American Society of Clinical Oncology, American Urological Association, Harris County Medical Society, Kidney Cancer Association, Society for Basic Urologic Research, Society of Urologic Oncology, Texas Medical Association

Disclosure: Nothing to disclose.

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Bladder Cancer Staging

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