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Bladder Cancer Treatment (Professional) (cont.)

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.[1] 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.[2] Pathologic grade, which is based on cellular atypia, nuclear abnormalities, and the number of mitotic figures is of great prognostic importance.

References:

  1. Mostofi FK, Davis CJ, Sesterhenn IA: Pathology of tumors of the urinary tract. In: Skinner DG, Lieskovsky G, eds.: Diagnosis and Management of Genitourinary Cancer. Philadelphia, Pa: WB Saunders, 1988, pp 83-117.
  2. Wilson TG, Pritchett TR, Lieskovsky G, et al.: Primary adenocarcinoma of bladder. Urology 38 (3): 223-6, 1991.

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.[4]

Table 1. Primary Tumor (T)a

a 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.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TaNoninvasive papillary carcinoma.
TisCarcinomain situ: "flat tumor."
T1Tumor invades subepithelial connective tissue.
T2Tumor invades muscularis propria.
pT2aTumor invades superficial muscularis propria (inner half).
pT2bTumor invades deep muscularis propria (outer half).
T3Tumor invades perivesical tissue.
pT3aMicroscopically.
pT3bMacroscopically (extravesical mass).
T4Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall.
T4aTumor invades prostatic stroma, uterus, vagina.
T4bTumor invades pelvic wall, abdominal wall.

Table 2. Regional Lymph Nodes (N)a,b

a 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.
b Regional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes.
NXLymph nodes cannot be assessed.
N0No lymph node metastasis.
N1Single regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node).
N2Multiple regional lymph node metastases in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node).
N3Lymph node metastases to the common iliac lymph nodes.

Table 3. Distant Metastasis (M)a

a 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.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa

StageTNM
a 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.
0aTaN0M0
0isTisN0M0
IT1N0M0
IIT2aN0M0
T2bN0M0
IIIT3aN0M0
T3bN0M0
T4aN0M0
IVT4bN0M0
Any TN1–3M0
Any TAny NM1

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.

References:

  1. Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988.
  2. Marshall VF: The relationship of the preoperative estimate to the pathologic demonstration of the extent of vesical neoplasms. J Urol 68(4): 714-723, 1952.
  3. Skinner DG: Current state of classification and staging of bladder cancer. Cancer Res 37 (8 Pt 2): 2838-42, 1977.
  4. 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.
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