Bladder Cancer (cont.)

Bladder cancer is staged using the tumor node metastases (TNM) system developed by the International Union Against Cancer (UICC) in 1997.

The tumor or the T stage is accorded by a pathological examination of the tumor specimen removed surgically. This refers to the depth of penetration of the tumor from the innermost lining to the deeper layers of the bladder. The T stages are as follows:

• Tx - Primary tumor cannot be evaluated



• T0 - No primary tumor



• Ta - Noninvasive papillary carcinoma (tumor limited to the innermost lining or the epithelium)



• Tis - Carcinoma in situ (flat tumor)



• T1 - Tumor invades connective tissue under the epithelium (surface layer)



• T2 - Tumor invades muscle of the bladder



• T2a - Superficial muscle affected (inner half)



• T2b - Deep muscle affected (outer half)



• T3 - Tumor invades perivesical (around the bladder) fatty tissue



• T3a - microscopically (visible only on examination under the microscope)



• T3b - macroscopically (for example, visible tumor mass on the outer bladder tissue)



• T4 - Tumor invades any of the following: prostate, uterus, vagina, pelvic wall, or abdominal wall

The node or the N stage is determined by the presence and extent of involvement of the lymph nodes in the pelvic region of the body near the urinary bladder. The N stages are as follows:

• Nx - Regional lymph nodes cannot be evaluated



• N0 - No regional lymph node metastasis



• N1 - Metastasis in a single lymph node < 2 cm in size



• N2 - Metastasis in a single lymph node > 2 cm, but < 5 cm in size, or multiple lymph nodes < 5 cm in size



• N3 - Metastasis in a lymph node > 5 cm in size

The metastases or the M stage signifies the presence or absence of the spread of bladder cancer to other organs of the body.

• Mx - Distant metastasis cannot be evaluated



• M0 - No distant metastasis



• M1 - Distant metastasis

The proper staging of bladder cancer is an essential step which has significant bearings on the management of this condition. The implications of bladder stage are...

• It helps select proper treatment for the patient. Superficial disease (Ta/T1/Tis) can generally be managed with less aggressive treatment as compared to invasive disease (T2/T3/T4).



• Invasive tumors have a higher likelihood of spread to lymph nodes and distant organs as compared to superficial tumors.



• The chances of cure and long-term survival progressively decrease as the bladder cancer stage increases.



• Staging allows proper classification of patients into groups for research studies and study of newer treatments.

Source: MedicineNet.com
http://www.medicinenet.com/bladder_cancer/article.htm