Jewett Staging for Bladder Cancer
Originally proposed by H.J. Jewett in 1946; revised by Marshall in 1956. Also called Jewett-Marshall Staging and AUS (American Urologic System).
Histologic staging based on depth of invasion through the bladder wall. It does not consider grade of tumor, local recurrence rate or multicentricity of tumors. It's important to have a deep resection.
Stage A Submucosal invasion but no involvement of muscle Stage B Bladder wall or muscle invasion, subdivided B1 superficial and B2 deep Stage C Extension through serosa into perivesical fat (around bladder) Stage D Lymph node and distant metastases, subdivided D1 regional nodes and D2 distant nodes and other distant metastases.
Guidelines for Jewett Staging:
- It is important to have a good surgical or biopsy specimen so that muscle layers can be seen and assessed.
- The prognostic dividing line is between B1 and B2, so be mindful of the description of the depth of muscle invasion.
- AJCC Tumor notation T1 to T4 parallels Jewett stages A, B, C, D; N (node) and M (metastases) are part of Jewett stage D.