Bladder Cancer Treatment (Professional) (cont.)
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Cellular Classification of Bladder Cancer
More than 90% of bladder carcinomas are transitional cell carcinomas derived from the uroepithelium. About 6% to 8% are squamous cell carcinomas, and 2% are adenocarcinomas. Adenocarcinomas may be either of urachal origin or of nonurachal origin; the latter type is generally thought to arise from metaplasia of chronically irritated transitional epithelium. Pathologic grade, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures is of great prognostic importance.
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 size and mobility of palpable masses, the degree of induration of the bladder wall, and the presence of extravesical extension or invasion of adjacent organs. Clinical staging, even when computed tomographic and/or magnetic resonance imaging scans and other imaging modalities are used, often underestimates the extent of tumor, particularly in cancers that are less differentiated and more deeply invasive.[1,2,3]
Definitions of TNM
The American Joint Committee on Cancer has designated staging by TNM classification to define bladder cancer.
Table 1. Primary Tumor (T)a
Table 2. Regional Lymph Nodes (N)a,b
Table 3. Distant Metastasis (M)a
Table 4. Anatomic Stage/Prognostic Groupsa
An older, less frequently used staging system was derived by comparing clinical estimates of stage with the pathologic stage of radical cystectomy specimens.[2,3] To better ensure uniform staging and reporting of clinical results, the use of the modern TNM classification described above is recommended.
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