Urology Tumor Staging

Staging for the common urological cancers can be found here. These are based on the UICC TNM Classification of Malignant Tumours 7th Edition (published in 2010). Visit our General Cancer Information Page for a description of the how the TNM system is used.

+ Bladder

T Stage
 Primary Tumor
Tx
 Primary tumour cannot be assessed
T0
 No evidence of primary tumor
Tis
 Carcinoma in situ
Ta
 Non-invasive papillary carcinoma
T1
 Tumor invades subepithelial connective tissue
T2
 Tumor invades muscle
T2a Tumour invades superficial muscle (inner half)
T2a Tumour invades deep muscle (outer half)
T3
 Tumour invades perivesical tissue:
T3a microscopically
T3b macroscopically (extravesical mass)
T4
 Tumour invades any of the following: prostate stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall
T4a Tumour invades prostate stroma, seminal vesicles, uterus, vagina
T4b Tumour invades pelvic wall or abdominal wall

N Stage
 Regional Lymph Nodes
NX
 Regional lymph nodes cannot be assessed
N0
 No regional lymph node metastasis
N1
 Metastasis in a single lymph node in the true pelvis (hypogastric, obturator, external iliac, or presacral)
N2
 Metastasis in a multiple lymph nodes in the true pelvis (hypogastric, obturator, external iliac, or presacral)
N3
 Metastasis in a common iliac lymph node(s)

M Stage
 Distant Metastasis
M0
 No distant metastases
M1
 Distant metastases


Stage Grouping T-stage
 N-stage
 M-stage
Stage 0a Tis
 N0 M0
Stage 0is
 Tis
 N0 M0
Stage I
 T1
 N0 M0
Stage II
 T2a, b
 N0 M0
Stage III
 T3a, b
 N0
 M0
T4a N0 M0
Stage IV
 T4b
 N0
 M0
Any T
 N1, N2, N3
 M0
Any T
 Any N
 M1
 

+ Kidney

T Stage
 Primary Tumor
Tx
 Cannot be assessed
T0
 No evidence of primary tumor
T1
 Tumor 7 cm or less in greatest dimension, limited to the kidney
T1a Tumor 4 cm or less
T1b Tumor more than 4 cm but not more than 7 cm
T2
 Tumor more than 7 cm in greatest dimension, limited to the kidney
T2a Tumour more than 7 cm but not more than 10 cm
T2b Tumour more than 10 cm, limited to the kidney
T3
 Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota fascia
T3a Tumour grossly extends into the renal vein or its segmental (muscle containing) branches, or tumour invades perirenal and/or renal sinus fat (peripelvis) fat but not beyond Gerota fascia
T3b Tumour grossly extends into vena cava below diaphragm
T3c Tumour grossly extends into vena cava above the diaphragm or invades the wall of the vena cava
T4
 Tumor invades beyond Gerota fascia (including contiguous extension into the ipsilateral adrenal gland)


N Stage
 Regional Lymph Nodes
NX
 Regional lymph nodes cannot be assessed
N0
 No regional lymph node metastases
N1
 Metastasis in single regional lymph node
N2
 Metastasis in more than one regional lymph node


M Stage
 Distant Metastasis
M0
 No distant metastases
M1
 Distant metastases


Stage Grouping T-stage
 N-stage
 M-stage
Stage I
 T1
 N0 M0
Stage II
 T2
 N0 M0
Stage III
 T3
 N0
 M0
T1, T2, T3 M1 M0
Stage IV
 T4
 Any N
 M0
Any T
 N2
 M0
Any T
 Any N
 M1
 

+ Penis

T Stage
 Primary Tumor
Tx
 Cannot be assessed
T0
 No evidence of primary tumor
Tis
 Carcinoma in situ
Ta
 Non-invasive verrucous carcinoma
T1
 Tumor invades subepithelial connective tissue
T1a Tumor invades subepithelial connective tissue without lymphovascular invasion and is not poorly differentiated or undifferentiated
T1b Tumor invades subepithelial connective tissue with lymphovascular invasion and is poorly differentiated or undifferentiated
T2
 Tumor invades corpus spongiosum or cavernosum
T3
 Tumor invades urethra
T4
 Tumor invades other adjacent structures


N Stage
 Regional Lymph Nodes
NX
 Regional lymph nodes cannot be assessed
N0
 No palpable or visibly enlarged inguinal lymph nodes
N1
 Palpable mobile unilateral inguinal lymph nodes
N2
 Palpable mobile multiple or bilateral inguinal lymph nodes
N3
 Fixed inguinal nodal mass or pelvic lymphadenopathy unilateral or bilateral


M Stage
 Distant Metastasis
M0
 No distant metastases
M1
 Distant metastases


Stage Grouping T-stage
 N-stage
 M-stage
Stage 0 Tis
 N0 M0
Ta
 N0 M0
Stage I
 T1a
 N0 M0
Stage II
 T1b
 N0 M0
T2
 N0, N1
 M0
T3
 N0 M0
Stage IIIA
 T1, T2, T3
 N1
 M0
Stage IIIB
 T1, T2, T3 N2
 M0
Stage IV
 T4
 Any N
 M0
Any T
 N3
 M0
Any T
 Any N
 M0


 

+ Prostate

T Stage
 Primary Tumor
Tx
 Cannot be assessed
T0
 No evidence of primary tumor
T1
 Clinically inapparant tumour, neither palpable nor visible by imaging
T1a Tumor is a histological finding in 5% or less of tissue resected
T1b Tumor is a histological finding in more than 5% of tissue resected
T1c Tumor identified because of needle biopsy, e.g., because of elevated PSA
T2
 Tumor confined within prostaste
T2a Tumour involves one-half of one lobe or less
T2b Tumour involves more than one-half of one lobe, but not both lobes
T2c Tumour involves both lobes
T3
 Tumor extends through the prostatic capsule
T3a Extracapsular extension (unilateral or bilateral) including microscopic bladder neck involvement
T3b Tumor invades seminal vesicle(s)
T4
 Tumor is fixed or invades adjacent structures other than seminal vesicles: external sphincter, rectum, levator muscles, and/or pelvic wall


N Stage
 Regional Lymph Nodes
NX
 Regional lymph nodes cannot be assessed
N0
 No regional lymph nodes metastasis
N1
 Regional lymph node metastases


M Stage
 Distant Metastasis
M0
 No distant metastases
M1
 Distant metastases
M1a Non-regional lymph node(s)
M1b Bone(s)
M1c Other site(s)


Stage Grouping T-stage
 N-stage
 M-stage
Stage I
 T1, T2a
 N0 M0
Stage II
 T2b, T2c
 N0 M0
Stage III
 T3
 N0
 M0
Stage IV
 T4
 N0
 M0
Any T
 N1
 M0
Any T
 Any N
 M1
 

+ Renal Pelvis and Ureter

T Stage
 Primary Tumor
Tx
 Primary tumour cannot be assessed
T0
 No evidence of primary tumor
Tis
 Carcinoma in situ
Ta
 Non-invasive papillary carcinoma
T1
 Tumor invades subepithelial connective tissue
T2
 Tumor invades muscularis
T3
 (Renal pelvis) Tumor invades beyond muscularis into peripelvic fat or renal parenchyma
(Ureter) Tumor invades beyond muscularis into periureteric fat
T4 Tumour invades into adjacent organs or through the kidney into perinephric fat


N Stage
 Regional Lymph Nodes
NX
 Regional lymph nodes cannot be assessed
N0
 No regional lymph node metastasis
N1
 Metastasis in a single lymph node 2 cm or less in greatest dimension
N2
 Metastasis in a single lymph node more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, none more than 5 cm in greatest dimension
N3
 Metastasis in a lymph node more than 5 cm in greatest dimension


M Stage
 Distant Metastasis
M0
 No distant metastases
M1
 Distant metastases


T-stage
 N-stage
 M-stage
Stage 0a Tis
 N0 M0
Stage 0is
 Tis
 N0 M0
Stage I
 T1
 N0 M0
Stage II
 T2
 N0 M0
Stage III
 T3
 N0
 M0
Stage IV
 T4
 N0
 M0
Any T
 N1, N2, N3
 M0
Any T
 Any N
 M1
 

+ Testis

T Stage
 Primary Tumor
Tx
 Cannot be assessed
T0
 No evidence of primary tumor
Tis
 Intratubular germ cell neoplasia (carcinoma in situ)
T1
 Tumor limited to testis and epididymis without vascular/lymphatic invasion; tumour may invade tunica albuginea but not tunica vaginalis
T2
 Tumor limited to testis and epididymis with vascular/lymphatic invasion, or tumour extending through tunica albuginea with involvement of tunica vagialis
T3
 Tumor invades spermatic cord with or without vascular/lymphatic invasion
T4
 Tumor invades scrotum with or without vascular/lymphatic invasion


N Stage
 Regional Lymph Nodes
NX
 Regional lymph nodes cannot be assessed
N0
 No regional lymph node metastases
N1
 Metastasis with a lymph node mass 2 cm or less in greatest dimension or multiple lymph nodes, none more than 2 cm in greatest dimension
N2
 Metastasis with a lymph node mass more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, any one mass more than 2 cm but nor more than 5 cm in greatest dimension
N3
 Metastasis with lymph node mass more than 5 cm in greatest dimension


M Stage
 Distant Metastasis
M0
 No distant metastases
M1
 Distant metastases
M1a Non-regional lymph node(s) or lung metastasis
M1b Distant metastasis other than non-regional lymph nodes and lung


S Stage
 Serum Tumour Markers
SX
 Serum markers studies not available
S0
 Serum marker study levels within normal limits
S1
 LDH <1.5 x N and beta hCG <5000 and AFP <1000
S2
 LDH 1.5-10 x N or beta hCG 5000-50,000 or AFP 1000-10,000
S3 LDH >10 x N or beta hCG >50,000 or AFP >10,000


Staging Group T-stage
 N-stage
 M-stage
 Serum Marker
Stage 0 pTis
 N0 M0 S0, SX
Stage I
 pT1-T4
 N0 M0 SX
Stage IA
 pT1 N0 M0 S0
Stage IB pT2-T4 N0 M0 S0
Stage IS Any pT/TX N0 M0 S1-S3
Stage II
 Any pT/TX
 N1-3 M0 SX
Stage IIA Any pT/TX N1
 M0 S0
Any pT/TX N1 M0 S1
Stage IIB Any pT/TX N2 M0 S0
Any pT/TX N2 M0 S1
Stage IIC Any pT/TX N3 M0 S0
Any pT/TX N3 M0 S1
Stage III
 Any pT/TX
 Any N M1a SX
Stage IIIA Any pT/TX Any N M1a S0
Any pT/TX Any N M1a S1
Stage IIIB Any pT/TX N1-N3
 M0 S2
Any pT/TX Any N M1a S2
Stage IIIC Any pT/TX N1-N3
 M0 S3
Any pT/TX Any N M1a S3
Any pT/TX Any N M1b Any S
 

+ Urethra (Male and Female)

T Stage
 Primary Tumor
Tx
 Primary tumour cannot be assessed
T0
 No evidence of primary tumor
Tis
 Carcinoma in situ
Ta
 Non-invasive papillary, polypoid or verrucous carcinoma
T1
 Tumor invades subepithelial connective tissue
T2
 Tumor invades any of the following: corpus spongiosum, prostate or periurethral muscle
T3
 Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension)
T4
 Tumour invades other adjacent organs (invasion of the bladder)


T Stage
 Primary Tumor
Tis pu
 Carcinoma in situ, involvement of the prostatic urethra
Tis pd
 Carcinoma in situ, involvement of the prostatic ducts
T1
 Tumor invades subepithelial connective tissue
T2
 Tumor invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle
T3
 Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension)
T4
 Tumour invades other adjacent organs (invasion of the bladder)


N Stage
 Regional Lymph Nodes
NX
 Regional lymph nodes cannot be assessed
N0
 No regional lymph node metastasis
N1
 Metastasis in a single lymph node 2 cm or less in greatest dimension
N2
 Metastasis in a single lymph node more than 2 cm in greatest dimension or multiple lymph nodes


M Stage
 Distant Metastasis
M0
 No distant metastases
M1
 Distant metastases


Stage Grouping T-stage
 N-stage
 M-stage
Stage 0a Tis
 N0 M0
Stage 0is
 Tis
 N0 M0
Tispu N0 M0
Tispd N0 M0
Stage I
 T1
 N0 M0
Stage II
 T2
 N0 M0
Stage III
 T1, 2
 N1
 M0
T3 N0, N1
 M0
Stage IV
 T4
 N0, N1
 M0
Any T
 N2 M0
Any T
 Any N
 M1