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Guidelines

Muscle-invasive and Metastatic Bladder Cancer

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  1. Introduction
  2. Methods
  3. Epidemiology Aetiology And Pathology
  4. Staging And Classification Systems
  5. Diagnostic Evaluation
  6. Markers
  7. Disease Management
  8. Follow Up
  9. References
  10. Conflict Of Interest
  11. Citation Information
  12. Copyright And Terms Of Use
4. Staging And Classification Systems
  • 1. Introduction
  • 2. Methods
  • 3. Epidemiology Aetiology And Pathology
  • 4. Staging And Classification Systems
  • 5. Diagnostic Evaluation
  • 6. Markers
  • 7. Disease Management
  • 8. Follow Up
  • 9. References
  • 10. Conflict Of Interest
  • 11. Citation Information
  • 12. Copyright And Terms Of Use
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4. STAGING AND CLASSIFICATION SYSTEMS

4.1. Pathological staging

For staging, the Tumour, Node, Metastasis (TNM) Classification (2017, 8th edition) is recommended [83]. Blood and lymphatic vessel invasion have an independent prognostic significance [84,85].

4.2. Tumour, node, metastasis classification

The TNM classification of malignant tumours is the method most widely used to classify the extent of cancer spread [83] (Table 4.1).

Table 4.1: TNM Classification of urinary bladder cancer [83]

T - Primary Tumour
TxPrimary tumour cannot be assessed
T0No evidence of primary tumour
TaNon-invasive papillary carcinoma
TisCarcinoma in situ: “flat tumour”
T1Tumour invades subepithelial connective tissue
T2Tumour invades muscle
 T2aTumour invades superficial muscle (inner half)
 T2bTumour invades deep muscle (outer half)
T3Tumour invades perivesical tissue:
 T3amicroscopically
 T3bmacroscopically (extravesical mass)
T4Tumour invades any of the following: prostate stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall
 T4aTumour invades prostate stroma, seminal vesicles, uterus, or vagina
 T4bTumour invades pelvic wall or abdominal wall
N - Regional Lymph Nodes
NxRegional lymph nodes cannot be assessed
N0No regional lymph node metastasis
N1Metastasis in a single lymph node in the true pelvis (hypogastric, obturator, external iliac, or presacral)
N2Metastasis in multiple regional lymph nodes in the true pelvis (hypogastric, obturator, external iliac, or presacral)
N3Metastasis in a common iliac lymph node(s)
M - Distant Metastasis
M0No distant metastasis
 M1aNon-regional lymph nodes
 M1bOther distant metastasis

Staging after neoadjuvant chemotherapy (NAC) and RC can be done, but must be mentioned as ypTNM (International Collaboration on Cancer Reporting) [86]. ypT0N0 after NAC and cystectomy is associated with better prognosis [71,87,88].

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