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Chapter 16 – Bladder Cancer in the Elderly

The most widely accepted staging classification is the TNM system (UICC 2009).

It is clinical (T) and pathological (PT). After a transurethral resection of the bladder (TURB), the pT stage must be only considered as minimal.

T or primary tumour:

* Clinically (pelvis examination under anaesthesia)

  • T1: normal pelvis
  • T2: mobile pelvic mass no longer present after TURB
  • T3: mobile pelvic mass still present after TURB
  • T4: fixed mass

* Pathology

  • Tx: primary cannot be assessed.
  • T0: no evidence of primary.
  • pTa: non-invasive, limited to the mucosa.
  • pTis: (Cis), flat tumour limited to the mucosa.
  • pT1: infiltration of the basal membrane and limited to the sub-epithelial connective tissue.
  • pT2: muscle invasive;
    • T2a: inner half;
    • T2b: outer half.
  • pT3: invasion of the perivesical fat;
    • T3a: microscopic invasion;
    • T3b: macroscopic invasion.
  • pT4: invasion of neighbouring structures;
    • T4a: prostate, uterus, vagina;
    • T4b: pelvis or abdominal wall.

N or regional nodes:

The nodes located within the true pelvis are considered as regional lymph nodes.

  • Nx: no information on nodal status.
  • N0: no evidence of tumour within the nodes examined.
  • N1: tumour present in a single node
  • N2: metastasis in multiple nodes in the true pelvis
  • N3: metastases in the common iliac nodes

M or distant metastasis:

  • Mx: no information on M.
  • M0: absence of distant metastasis.
  • M1: distant metastasis.

Histopathological grading (G): 2 classifications co-exist, overlap, and may be used

1973 classification: G1 well differentiated, G2 moderately differentiated. G3–4 poorly differentiated.

2004 WHO classification: urothelial Papilloma (benign lesion), PUNLMP, low grade, high grade carcinoma.

Additional descriptors include lymphatic vessel invasion (L) and venous invasion (V).

Accurate pathological diagnosis and staging of BC represent the cornerstone for treatment strategy.

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