Urinary Bladder

TNM 7 Classification

TNM 6 Classification

1. Rules for Classification

The classification applies to carcinomas. Papilloma is excluded. There should be histological or cytological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories:

T categories. Physical examination, imaging, and endoscopy
N categories. Physical examination and imaging
M categories. Physical examination and imaging

2. Regional Lymph Nodes

The regional lymph nodes are the nodes of the true pelvis, which essentially are the pelvic nodes below the bifurcation of the common iliac arteries. Laterality does not affect the N classification.

3. TNM Clinical Classification

3.1. T - Primary Tumour

The suffix (m) should be added to the appropriate T category to indicate multiple tumours. The suffix (is) may be added to any T to indicate presence of associated carcinoma in situ.

TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Ta. Noninvasive papillary carcinoma
Tis. Carcinoma in situ: "flat tumour"
T1. Tumour invades subepithelial connective tissue
T2. Tumour invades muscle
   T2a. Tumour invades superficial muscle (inner half)
   T2b. Tumour invades deep muscle (outer half)
T3. Tumour invades perivesical tissue:
   T3a. microscopically
   T3b. macroscopically (extravesical mass)
T4. Tumour invades any of the following: prostate, uterus, vagina, pelvic wall, abdominal wall
   T4a. Tumour invades prostate, uterus, or vagina
   T4b. Tumour invades pelvic wall or abdominal wall

3.2. N - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Metastasis in a single lymph node 2 cm or less in greatest dimension
N2. Metastasis in a single lymph node more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, none more than 5 cm in greatest dimension
N3. Metastasis in a lymph node more than 5 cm in greatest dimension

3.3. M - Distant Metastasis

MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis

4. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.

5. G Histopathological Grading

GX. Grade of differentiation cannot be assessed
G1. Well differentiated
G2. Moderately differentiated
G3-4. Poorly differentiated/undifferentiated

6. Stage Grouping

Stage 0a Ta N0 M0 Stage 0is Tis N0 M0 Stage I T1 N0 M0 Stage II T2a. b N0 M0 Stage III T3a. b N0 M0 T4a N0 M0 Stage IV T4b N0 M0 Any T N1. N2. N3 M0 Any T Any N M1

7. Summary

Urinary Bladder Ta Noninvasive papillary Tis In situ: "flat tumour" T1 Subepithelial connective tissue T2 Muscularis T2a Inner half T2b Outer half T3 Beyond muscularis T3a Microscopically T3b Extravesical mass T4a Prostate, uterus, vagina T4b Pelvic wall, abdominal wall N1 Single ≤2 cm N2 Single >2 to 5 cm, multiple ≤5 cm N3 >5 cm