Extent Of Local Tumour Spread

Border: pushing/infiltrative. Lymphocytic reaction: prominent/sparse.

The TNM classification applies to urinary bladder carcinomas (non-invasive and invasive) and also papillary urothelial (transitional cell) neoplasm of low malignant potential (see above).

pTis carcinoma in situ: potential multifocal urinary tract field change pTa papillary non-invasive pTl invasion of subepithelial connective tissue pT2a invasion of superficial muscle (inner half)

pT2b invasion of deep muscle (outer half)

pT3 invasion of perivesical fat:

a. microscopically b. extravesical mass (macroscopically) pT4 invasion of:

a. prostate, uterus, vagina b. pelvic wall, abdominal wall.

Direct invasion of distal ureter is classified by the depth of greatest invasion in any of the involved organs.

Invasive bladder cancer with associated in-situ change extending into prostatic urethra or duct epithelium is classified according to the depth of bladder wall invasion and comment on the in-situ changes noted by use of a suffix, e.g. pT2b (ispu) for prostatic urethral involvement.

Involvement of prostatic urethra or stroma by invasive disease is pT4a, as is small or large intestine, peritoneum covering the bladder and seminal vesicles.

Superficial tumours are regarded as either pTa or pT1 and are often histological grade I or II. Formal substaging of pT1 bladder tumours is not usually done but comment should be made on the degree of invasion, e.g. focal or extensive, above/at/below muscularis mucosae (pTla: cores of papillae; pTlb: lamina propria; pTlc: below muscularis mucosae).

Deeply (muscle) invasive tumours are pT2 or pT3 and more often grade III. They are prognostically adverse, requiring more radical treatment and assessment of invasion of the detrusor layer of muscularis propria is of crucial importance in their designation. As well as invasion of the

Epithelium

Lamina propria Muscularis mucosae

Submucosa

Inner 1/2 Muscularis propria Outer 1/2

Perivesical fat pTis pfa

The surface component may be exophytic/papillary or sessile pTI pT2a pT2b pT3a pT3b pT4a pT4b pTis pfa

The surface component may be exophytic/papillary or sessile pTI pT2a pT2b pT3a pT3b pT4a pT4b

Pt4b Tumour
Figure 30.1. Urinary bladder carcinoma.

bladder wall, urothelial cancer can extend into the bladder neck, prostate, urethra and seminal vesicles. Because of this, urethral biopsy is done in staging patients with CIS or high-grade invasive disease and en bloc prostatourethrectomy favoured at the time of cystectomy.

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