Bladder Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Stage Information for Bladder Cancer The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall by the tumor. This determination requires a cystoscopic examination that includes a biopsy and examination under anesthesia to assess the following:

• Size and mobility of palpable masses.
• Degree of induration of the bladder wall.
• Presence of extravesical extension or invasion of adjacent organs.

Clinical staging, even when computed tomographic (CT) and/or magnetic resonance imaging (MRI) scans and other imaging modalities are used, often underestimates the extent of tumor, particularly in cancers that are less differentiated and more deeply invasive. CT imaging is the standard staging modality. A clinical benefit from obtaining MRI or positron emission tomography scans rather than CT imaging has not been demonstrated.[1,2]

AJCC Stage Groupings and TNM Definitions

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define bladder cancer.[3]

Table 1. Definitions of TNM Stages 0 and 0is

Stage	TNM	Description	Illustration
T = primary tumor; N = regional lymph nodes; M = distant metastasis.
Reprinted with permission from AJCC: Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497-505.
0a
	Ta, N0, M0
		Ta = Noninvasive papillary carcinoma.
	N0 = No lymph node metastasis.
	M0 = No distant metastasis.
	0is	Tis, N0, M0	Tis = Carcinomain situ: "flat tumor."
			N0 = No lymph node metastasis.
			M0 = No distant metastasis.

Table 2. Definition of TNM Stage I

Stage	TNM	Description	Illustration
T = primary tumor; N = regional lymph nodes; M = distant metastasis.
Reprinted with permission from AJCC: Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497-505.
I
	T1, N0, M0
		T1 = Tumor invades subepithelial connective tissue.
	N0 = No lymph node metastasis.
	M0 = No distant metastasis.

Table 3. Definition of TNM Stage II

Stage	TNM	Description	Illustration
T = primary tumor; N = regional lymph nodes; M = distant metastasis.
Reprinted with permission from AJCC: Urinary bladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 497-505.
II
	T2a, N0, M0
		T2a = Tumor invades superficial muscularis propria (inner half).
	N0 = No lymph node metastasis.
	M0 = No distant metastasis.
T2b, N0, M0	T2b = Tumor invades deep muscularis propria (outer half).
	N0 = No lymph node metastasis.
	M0 = No distant metastasis.

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