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Staging

Criteria for TNM Clinical Staging: Physical examination and history, histologic confirmation of tumor, bimanual examination under anesthesia, cystoscopy, urinary cytology, pyelography, imaging (radiographic and computer assisted), and other evaluations to determine metastatic involvement; lymphography (CT or lymphangiography) is required for nodal evaluation. Confirmation of extent of disease should include a biopsy deep enough to assess the depth of invasion at the base of the tumor.

Criteria for TNM Pathologic Staging: Total cystectomy and lymph node resection are required for pathologic staging.

The TNM staging system is a refinement of the Jewett system.

Comparison of AJCC and Jewett-Strong-Marshall Staging Systems

TNM Classification Jewett-Strong Marshall Definition
Tis 0 Limited to mucosa, flat insitu
Ta 0 Limited to mucosa, papillary
T1 A Lamina propria invaded
T2a B1 < halfway through muscularis
T2b B2 > halfway through muscularis
T3 C Perivesical fat
T4a C Prostate, uterus or vagina
T4b C Pelvic wall or abdominal wall
N1-N3 D1 Pelvic lymph node(s) involved
M1 D2 Distant metastases
Illustration of the bladder showing the TNM classifications.

Jewett Staging

Pathologist H.J. Jewett proposed this classification system in 1946. It was revised by Marshall in 1956, so it is also called Jewett-Marshall Staging and AUS (American Urologic System). This is a histologic staging based on depth of tumor invasion through bladder wall. Jewett's staging does not consider grade of tumor, local recurrence rate or multicentricity of tumors.

Collaborative Stage Elements

For more details on Collaborative Stage, see the Intro to Collaborative Staging module.