Staging of bladder cancer

Abstract

Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.

Recurrence in Non-Muscle Invasive Bladder Cancer Patients: External Validation of the EORTC, CUETO and EAU Risk Tables and Towards a Non-Linear Survival Model

“…Next to grading of the tumor, also its staging introduces subjectivity. Assessment of the muscular is propria is found to be difficult, and thereby the pT1 tumors are frequently down-staged (up to 56%) or up-staged (up to 13%) in assessments made by other pathologists [21]. This variability is however most likely not only induced by pathologists, also urologists can introduce subjectivity by missing lesions, in particular CIS.…”

Bladder cancer in women: a Sri Lankan study

“…Pathological grading was assessed according to the World Health Organisation (WHO) and International Society of Urological Pathology (ISUP) classification 2004 [9]. Tumours were staged according to TNM classification: pTa = non-invasive papillary carcinomas, pT1 = tumours that invade sub-epithelial connective tissues and pT2 = muscle-invasive tumours [10].…”

Prognostic Value of c-Myc Immunohistochemical Expression in Muscle Invasive Urothelial Carcinoma of the Urinary Bladder: A Retrospective Study

“…All hematoxylin and eosin (H and E) stained sections were re-evaluated independently by three pathologists to determine the variant and divergent differentiation of UC, presence of bilharziasis, perineural invasion (PNI), lymphovascular invasion (LVI), necrosis and pathological TNM stage. The tumors were re-staged according to American Joint Committee on Cancer (AJCC) staging system, 8 th edition (Magers et al, 2019) and histological variants were classified according to World Health Organization (WHO) classification of tumors of the urinary tract, 2016 (Humphrey et al, 2016). During the process of re-evaluation, three architectural patterns of tumor invasion were determined following the definition by (Jimenez et al, 2000).…”