Introduction

Bladder cancer is a common tumor of the urinary tract. Staging of disease is important as it gives some indication of prognosis and helps determine clinical management. It also allows some comparison of treatment response and comparison between patients [1].

Staging of bladder cancer is based on depth of tumor invasion of the bladder wall, involvement of local structures, nodal involvement and metastases. The bladder can be divided into layers: The mucosa (epithelium) lies over the submucosa or lamina propria. Beneath this is the muscular layer and beyond this is the serosa (the serosa is not present over the entire bladder as it is synonymous with the peritoneal covering which is applied over the dome) [2–4]. Staging systems for local disease are based on these layers. There are two main staging classifications used for evaluating bladder carcinoma: the TNM classification [5] and the Jewett–Strong–Marshall classification [6]. The TNM classification was revised in 1997, with a new stage added to differentiate between microscopic and macroscopic perivesical disease, a modification which has been retained in more recent versions (Table 4.1).

Clinical staging is evaluated by a combination of imaging, bimanual palpation, cystoscopic evaluation and biopsy [1,2]. Ideally, imaging would be performed prior to cystoscopy and biopsy to minimize potential imaging artifacts. In practice, however, cystoscopy and biopsy are performed at the initial presentation. Cystoscopic resection may completely remove the tumor and allow staging based on the histology (see Chapter 1).