Staging of Bladder Cancer

Pathologic stage is the most important determinant of prognosis and treatment for bladder cancer. An ideal staging system should accurately reflect the natural history of cancer, describe the total cancer burden, assess the extent of spread at the time of diagnosis, and stratify patients into prognostic groups for treatment planning. Stage T0 tumor is defined as no evidence of residual carcinoma after treatment. Multivariate analysis showed that lymphovascular invasion and carcinoma in situ in transurethral resection specimens were independent predictors of adverse clinical outcome. Stage pT2 carcinoma is defined as tumor invasion into the muscularis propria. Stage pT3 bladder carcinoma is defined as tumor invasion into perivesical soft tissue. Intramural adipose tissue is well-documented in the bladder, so the presence of fat invasion in a biopsy or transurethral resection specimen does not necessarily indicate invasive pT3 carcinoma. The common sites of distant metastasis include liver, lung, bone, adrenal, and gastrointestinal tract.