- Further information: Urinary bladder
Urothelial carcinoma displays more crowding and layering, and more hyperchromasia and mitoses, than papillomas and papillary urothelial neoplasm of low malignant potential (also included in grading table below for comparison).
Also consider non-urothelial cancer types (together constituting 5% of urinary bladder cancers): squamous cell carcinomas, adenocarcinomas, sarcomas, small cell carcinomas, and secondary deposits from cancers elsewhere in the body.
If urothelial carcinoma, perform grading and staging.
|Papillary urothelial neoplasm of low malignant potential||Low grade||High grade|
|Nuclei||Size and nuclear/cytoplasmic ratio||Mildly increased||Increased|
|Nuclear size variability||No||Some||Marked|
- Low grade
- High grade
T (Primary tumor)
- TX Primary tumor cannot be assessed
- T0 No evidence of primary tumor
- Ta Non-invasive papillary carcinoma
- Tis Carcinoma in situ ('flat tumor')
- T1 Tumor invades subepithelial connective tissue
- T2a Tumor invades superficial muscle (inner half of the detrusor muscle)
- T2b Tumor invades deep muscle (outer half of the detrusor muscle)
- T3 Tumor invades perivesical tissue:
- T3a Microscopically
- T3b Macroscopically (extravesical mass)
- T4a Tumor invades prostate, uterus or vagina
- T4b Tumor invades pelvic wall or abdominal wall
N (Lymph nodes)
- NX Regional lymph nodes cannot be assessed
- N0 No regional lymph node metastasis
- N1 Metastasis in a single lymph node in true pelvis (hypogastric, obturator, external iliac, or presacral nodes)
- N2 Metastasis in multiple lymph nodes in true pelvis (hypogastric, obturator, external iliac, or presacral nodes)
- N3 Metastasis in common iliac lymph nodes
M (Distant metastasis) Can be performed if tissues have been submitted from distant sites.
- MX Distant metastasis cannot be assessed
- M0 No distant metastasis
- M1 Distant metastasis.
- M1a: The cancer has spread only to lymph nodes outside of the pelvis.
- M1b: The cancer has spread other parts of the body.
- Histopathologic type of cancer
- Stage. For biopsies, there should be a mention of the presence or absence of the muscularis propria in the sample, and if it is involved.
- See also: General notes on reporting
- . Types of Bladder Cancer: TCC & Other Variants. CTCA.
- Rugvedita Parakh. Bladder, ureter & renal pelvis - Urothelial neoplasms-noninvasive - Noninvasive papillary urothelial carcinoma low grade. Pathology Outlines. Topic Completed: 1 December 2014. Minor changes: 30 March 2020
- Grignon, David J (2009). "The current classification of urothelial neoplasms ". Modern Pathology 22 (S2): S60–S69. doi:10.1038/modpathol.2008.235. ISSN 0893-3952.
- . EAU Guidelines - STAGING AND CLASSIFICATION SYSTEMS. Uroweb.
- "Staging of bladder cancer ". Histopathology 74 (1): 112–134. January 2019. doi:10.1111/his.13734. PMID 30565300.
- . Bladder Cancer: Stages and Grades. Cancer.net. Approved by the Cancer.Net Editorial Board 05/2019