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Bladder Cancer Staging: TNM Classification


Bladder cancer staging helps to determine the disease prognosis and to select an appropriate treatment strategy.

TNM is the most commonly used system for staging bladder cancers by the medical community.

“T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (a, is, 1, 2a, 2b, 3, 4a, and 4b), N (0, 1, 2, and 3), and M (0, 1a, and 1b) provide more details about each of these factors.

Higher the number means higher the severity of the disease. Once T, N, and M categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.

Bladder Cancer - T Staging - Infographic
Bladder Cancer - T Staging
Bladder Cancer - N and M Staging - Infographic
Bladder Cancer - N and M Staging

Following table describe the characteristics of bladder cancer according to different stages:

STAGE TNM DESCRIPTION
0a Ta N0 M0 Non-invasive papillary carcinoma also known as the papillary urothelial neoplasm of low malignant potential (PUNLMP)
0is Tis N0 M0 Carcinoma in situ (Flat tumor; Pre-cancerous or cancer cells present only in the superficial layer of bladder mucosa)
I T1 N0 M0 Tumor invades lamina propria (subepithelial connective tissue)
II T2a N0 M0 Tumor invades the inner muscular layer (superficial muscularis propria)
OR
T2b N0 M0 Tumor invades the outer muscular layer (deep muscularis propria)
IIIA T3 N0 M0 Tumor invades the perivesical tissue (fatty tissue around bladder)
OR
T4a N0 M0 Tumor invades the surrounding structures like prostate, seminal vesicles, uterus, vagina
OR
T1-4a N1 M0 Tumor limited to bladder on invading surrounding structures like prostate, seminal vesicles, uterus, vagina and has spread to one regional lymph node in true pelvis.
IIIB T1-4a N2-3 M0 Tumor limited to bladder on invading surrounding structures like prostate, seminal vesicles, uterus, vagina and has spread to multiple regional lymph node in true pelvis and/or common iliac lymph nodes.
IVA T4b Any N M0 Tumor invades the pelvic wall or abdominal wall with or without regional lymph nodes involvement.
OR
Any T Any N M1a Tumor spread to lymph nodes beyond common iliacs (non-regional)
IVB Any T Any N M1b Tumor spread to one or more distant organs such as lungs, bones, liver, peritoneum, etc.

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Watch the video below where Cancerbro explains the TNM STAGING of bladder cancer.

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