Bladder Cancer Staging 

Updated: Aug 17, 2018
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: E Jason Abel, MD  more...
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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

 

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

 

Any T

Any N

M1a

Stage IVB

Any T

Any N

M1b