Radiation Oncology/Bladder/Staging

Bladder Cancer Staging AJCC 7th Edition (2009) Primary Tumor: Ta - non-invasive papillary carcinoma Tis - carcinoma in situ, "flat tumor" T1 - invades subepithelial connective tissue T2 - invades muscularis propria T2a - invades superficial muscle (inner half) T2b - invades deep muscle (outer half) T3 - invades perivesical tissue T3a - microscopically T3b - macroscopically (extravesical mass) T4 - invades other organs T4a - invades prostatic stroma, uterus, vagina T4b - invades pelvic wall, abdominal wall Regional Lymph Nodes: Regional nodes include (primary nodal drainage): hypogastric, obturator, iliac (int/ext), perivesical, sacral, presacral Regional nodes (secondary nodal drainage): common iliac N0 - none N1 - single LN metastasis in the true pelvis (below common iliac) N2 - multiple LN metastases in the true pelvis (below common iliac) N3 - metastases to the common iliac LNs Stage Grouping: Stage 0a - Ta N0M0 Stage 0is - Tis N0M0 Stage I - T1 N0 Stage II - T2 N0 Stage III - T3N0 or T4aN0 Stage IV - T4b or any N+ or M1 Changes from 6th Edition: For T4 via prostate invasion, must invade prostate stroma. Subepithelial invasion of the prostatic urethra is not sufficient to qualify for T4. N-stages reclassified Older staging systems AJCC 6th Edition (2002) Primary Tumor: Ta - non-invasive papillary carcinoma Tis - carcinoma in situ, "flat tumor" T1 - invades subepithelial connective tissue T2 - invades muscle T2a - invades superficial muscle (inner half) T2b - invades deep muscle (outer half) T3 - invades perivesical tissue T3a - microscopically T3b - macroscopically (extravesical mass) T4 - invades other organs T4a - invades prostate, uterus, vagina T4b - invades pelvic wall, abdominal wall Regional Lymph Nodes: Regional nodes are the nodes of the true pelvis below the common iliac. N1 - single LN, 2 cm or less N2 - single LN 2-5 cm; or multiple LN < 5 cm N3 - LN > 5 cm Stage Grouping: Stage 0a - Ta N0M0 Stage 0is - Tis N0M0 Stage I - T1 N0 Stage II - T2 N0 Stage III - T3N0 or T4aN0 Stage IV - T4b or any N+ or M1 AJCC 5th Edition (1997) No changes compared to 6th Edition AJCC 4th edition (1992) T1 (same), T2 (superficial muscle), T3a (deep muscle), T3b (perivesical fat), T4 (invades prostate, uterus, vagina, pelvic wall, abdominal wall) UICC Staging: 3rd Edition (1978) 3rd edition (1978) - T3 is deep muscle invasion (similar to T2b)