• Muscle Invasive Bladder Cancer

  Staging graph  –  grading explanation

  Posted by wendy on January 24, 2006 at 12:17 pm

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  To view a good illustration of the bladder lining and its varied depths, click here:
  http://www.urologyhealth.org/picturepopup.cfm?id=43

  Knowing how deep the tumor has penetrated is essential. Treatments depend on the stage and grade of the cancer. Staging, along with the knowing the aggressiveness or “grade” of the tumor (see below) will give an indication of the growth or spread. The “T”‘ stage refers to clinical staging only, meaning what can be seen with current diagnostic tools. Bladder cancer is notoriously understaged- up to 40% of the time.

  The “P” stage is the best determination of actual stage but can only be assessed by examining the bladder after its removal, thus the doctors refer to “P” stage, or pathological stage, only after radical cystectomy has been perfomed.

  The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define bladder cancer:
  T=Tumor, N+Nodes involved, M=metastasis

  TX Primary tumor cannot be assessed
  T0 No evidence of primary tumor
  Ta Noninvasive papillary carcinoma
  Tis Carcinoma in situ: “flat tumor”; CIS is always considered high grade, high risk in a blc diagnosis
  T1 Tumor invades subepithelial connective tissue [T1 is sometimes divided further into a, b and c]
  T2 Tumor invades muscle
  T2a -Tumor invades superficial muscle (inner half)
  T2b -Tumor invades deep muscle (outer half)
  T3 Tumor invades perivesical tissue (fat surrounding the bladder)
  T3a -microscopically
  T3b -macroscopically
  T4 Tumor invades any of the following: prostate, uterus, vagina, pelvic wall, or abdominal wall.
  T4a -Tumor invades the prostate, uterus, vagina
  T4b -Tumor invades the pelvic wall, abdominal wall

  N=nodes
  N0 – no cancer in any lymph nodes
  N1 – one affected lymph node smaller than 2cm across
  N2 – one affected lymph node larger than 2cm, but smaller than 5cm. 1 or more may be affected
  N3 – at least one affected lymph node larger than 5cm across

  M=metastasis
  M0 – no distant metastasis (spread)
  M1 – metastasis detected

  Stage 0 -Tis or Ta, N0, M0
  Stage I -T1, N0, M0
  Stage II -T2a, N0, M0 or T2b, N0, M0
  Stage III -T3a, N0, M0 or T3b, N0, M0 or T4a, N0, M0
  Stage IV -T4b, N0, M0, any T, N1-N3, M0, or any T, any N, M1

  Grading
  Tumor grade appears to correlate significantly with the natural history of transitional cell carcinoma. The higher the grade of the diagnosis, the higher the incidence of death from the disease within two years. Thus grade III would be considered an aggressive form of cancer. Some doctors rate with scale of I-IV but this is rarely used anymore.

  The World Health Organization (WHO) classification recognizes three grades of urothelial/transitional cell cancer.
  Grade 1 or I represents well-differentiated papillary tumors with limited abnormalities.
  Grade 2 or II represents tumors of intermediary risk
  Grade 3 or III a marked increase in the cell layers and cell size with obvious abnormalities

  Note: Carcinoma in situ (CIS) -a flat type of tumor that usally shows up alongside other tumor types- is considered aggressive/grade III in all diagnoses of bladder cancer.

  Wendy replied 18 years, 5 months ago 1 Member · 0 Replies
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