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Jewett Staging for Bladder Cancer

History:

Originally proposed by H.J. Jewett in 1946; revised by Marshall in 1956. Also called Jewett-Marshall Staging and AUS (American Urologic System).

Criteria:

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.

Categories:

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.