TNM BLADDER CANCER STAGING

Dr. Mahnaz RoayaeiRadiation OncologistAssistant Professor Isfahan University of Medical Sciences

AMERICAN JOINT COMMITTEE ON CANCER 2009 TNM BLADDER CANCER STAGING

• PRIMARY TUMOR (T)• REGIONAL LYMPH NODES(N)• DISTANT METASTASIS (M)

The primary pathologic substages of the TNM staging system

such as pT2a and pT2b, cannot be determined from TURBT

specimens.

Patients who have documented muscularis propria-invasive bladder cancer require an additional set of studies:

1. chest x-ray 2. CT scan3. liver function studies4. Creatinine , and electrolytes5. Bimanual examination6. MRI lymphangiography7. A prostatic urethra and bulbous urethra

biopsy

Tumor extends through the muscle to involve the full

thicknessof the bladder and

into the serosa

• CTS or MRI, are not reliable for staging.• Only, when they show unequivocal tumor

extension outside the bladder

Nonstromal invasive urothelial tumors of theprostate are not classified as T4, as the prognosis in this group is quite good

REGIONAL LYMPH NODES

N2 :Metastasis in multiple lymph nodes in primarydrainage region

N3: Common

iliac lymph node

involvement

DISTANT METASTASI

S (M)

Thanks for your attention

Ref of photographs:Color Atlas by Dr.Hamid Eemami

Associate Professor of Radiation OncologyIsfahan University of Medical Sciences