Urothelial carcinoma — TNM staging of bladder cancer (AJCC 8th)
Author: Faruk Skenderi, MD, PhDReviewed by: Semir Vranić, MD, PhDLast reviewed:
- Amin MB, et al., eds. AJCC Cancer Staging Manual. 8th ed. Springer; 2017.
- Paner GP, et al. Updates in the eighth edition of the tumor-node-metastasis staging classification for urologic cancers. Eur Urol. 2018;73(4):560-569. https://doi.org/10.1016/j.eururo.2017.12.018 (opens in new tab)
- Babjuk M, et al. European Association of Urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). Eur Urol. 2022;81(1):75-94. https://doi.org/10.1016/j.eururo.2021.08.010 (opens in new tab)
- WHO Classification of Tumours Editorial Board. Urinary and Male Genital Tumours. 5th ed. IARC; 2022.
A structured review of TNM staging for urothelial carcinoma of the urinary bladder: pT categories, nodal disease, and the muscle-invasion threshold that drives management.
- Ta — non-invasive papillary carcinoma; confined to the urothelium, no lamina propria invasion.
- Tis — carcinoma in situ ('flat tumour'); high-grade by definition, high progression risk.
- T1 — invades the subepithelial connective tissue (lamina propria); substaging (T1a/T1b around the muscularis mucosae) is increasingly reported.
- T2 — invades muscularis propria (detrusor): T2a inner half, T2b outer half. This is the threshold that separates non-muscle-invasive (NMIBC) from muscle-invasive bladder cancer (MIBC).
- T3 — invades perivesical soft tissue (T3a microscopic, T3b macroscopic / extravesical mass).
- T4 — invades adjacent structures: prostatic stroma, seminal vesicles, uterus, vagina (T4a) or pelvic/abdominal wall (T4b).
- N1 – single regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral); N2 – multiple regional lymph node metastases in the true pelvis; N3 – lymph node metastasis to the common iliac nodes; no size criteria in the 8th edition.
- Always specify presence/absence of muscularis propria in the specimen — its absence in a T1 biopsy mandates re-resection.
- Report lymphovascular invasion, variant histology (micropapillary, plasmacytoid, sarcomatoid, nested), and CIS in adjacent mucosa.