Summary Stage 2018: Bladder
Summary Stage 2018
Notes
**Bladder**
C670-C679
C670 Trigone of bladder
C671 Dome of bladder
C672 Lateral wall of bladder
C673 Anterior wall of bladder
C674 Posterior wall of bladder
C675 Bladder neck
C676 Ureteric orifice
C677 Urachus
C678 Overlapping lesion of bladder
C679 Bladder, NOS
**Note 1:** The following sources were used in the development of this schema
* SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf)
* SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/)
* Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx
* Chapter 62 *Urinary Bladder*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
**Note 2:** The two main types of bladder cancer are the flat (sessile) variety and the papillary type. The flat (sessile) variety is called in situ when tumor has not penetrated the basement membrane. Papillary tumor that has not penetrated the basement membrane is called noninvasive.
**Note 3:** Noninvasive papillary transitional carcinoma: Pathologists use many different descriptive terms for noninvasive papillary transitional cell carcinoma. Frequently, the pathology report does not contain a definite statement of non-invasion; however, non-invasion can be inferred from the microscopic description.
A. Definite statements of non-invasion for papillary transitional cell carcinomas (Ta) include
Noninfiltrating
Noninvasive
No evidence of invasion
No extension into lamina propria
No stromal invasion
No extension into underlying supporting tissue
Negative lamina propria and superficial muscle
Negative muscle and (subepithelial) connective tissue
No infiltrative behavior/component
B. Inferred descriptions of non-invasion for papillary transitional cell carcinomas include
No involvement of muscularis propria and no mention of subepithelium/submucosa
No statement of invasion (microscopic description present)
(Underlying) Tissue insufficient to judge depth of invasion
No invasion of bladder wall
No involvement of muscularis propria
Benign deeper tissue
Microscopic description problematic (non-invasion versus superficial invasion)
Frond surfaced by transitional cell
No mural infiltration
No evidence of invasion (no sampled stroma)
Confined to mucosa
**Note 4:** Noninvasive (in situ) flat transitional cell carcinoma: Careful attention must be given to the use of the term "confined to mucosa" for flat bladder carcinomas. Historically, carcinomas described as "confined to mucosa" were coded as localized. However, pathologists use this designation for non-invasion as well. Pathologists also vary in their use of the terms "invasion of mucosa, grade 1" and "invasion of mucosa, grade 2" to distinguish between noninvasive and invasive carcinomas. In order to accurately code tumors described as "confined to mucosa", abstractors should determine
* If the tumor is confined to the epithelium: then it is noninvasive (IS).
* If the tumor has penetrated the basement membrane to invade the lamina propria: then it is invasive and coded to 1 for localized. The lamina propria and submucosa tend to merge when there is no muscularis mucosa, so these terms may be used interchangeably, along with stroma and subepithelial connective tissue.
* If the distinction between involvement of the epithelium and lamina propria cannot be made, then the tumor should be coded as "confined to mucosa, NOS" (IS).
* Statements meaning confined to mucosa, NOS for flat transitional cell carcinomas include
* Confined to mucosal surface
* Limited to mucosa, no invasion of submucosa and muscularis
* No infiltration/invasion of fibromuscular and muscular stroma
* Superficial, NOS
**Note 5:** Code 2 for regional if the only description of extension is through full thickness of bladder wall, and there is no clear statement as to whether or not the cancer has extended into fat.
| SS2018 |
Description |
| 0 |
In situ: noninvasive, intraepithelial
- Nonpapillary
+ Carcinoma in situ, NOS
+ Sessile (flat) (solid) carcinoma in situ
+ Transitional cell carcinoma in situ
- Papillary
+ Non-infiltrating
+ Transitional cell carcinoma, stated to be non-invasive
+ Transitional cell carcinoma, with inferred description of non-invasion |
| 1 |
Localized only (localized, NOS)
- Mucosa, NOS
- Muscle (muscularis propria)
+ Deep muscle-outer half
+ Extension through full thickness of bladder wall
+ Superficial muscle-inner half
- Submucosa
+ Lamina propria
+ Stroma
+ Subepithelial connective tissue
+ Tunica propria |
| 2 |
Regional by direct extension only
- Adventitia
- Bladder is “fixed”
- Extravesical tumor, NOS
- Parametrium
- Periprostatic tissue
- Peritoneum
- Periureteral fat/tissue
- Perivesical fat/tissue
- Prostate
- Rectovesical/Denonvilliers’ fascia
- Seminal vesicle
- Serosa (mesothelium) (to/through)
- Tunica serosa (to/through)
- Ureter
- Urethra (including prostatic urethra)
- Uterus
- Vagina
- Vas deferens |
| 3 |
Regional lymph node(s) involved only
- Iliac, NOS
+ External
+ Internal (hypogastric)
- Obturator
- Pelvic, NOS
- Perivesical pelvic, NOS
- Sacral, NOS
+ Lateral (laterosacral)
+ Presacral
+ Sacral promontory (Gerota’s)
- Regional lymph node(s), NOS
+ Lymph node(s), NOS |
| 4 |
Regional by BOTH direct extension AND regional lymph node(s) involved
- Codes (2) + (3) |
| 7 |
Distant site(s)/lymph node(s) involved
- Distant site(s) (including further contiguous extension)
+ Abdominal wall
+ Bone
+ Colon
+ Large intestine including rectum
+ Pelvic wall
+ Pubic bone
+ Small intestine
- Distant lymph node(s), NOS
+ Common iliac
- Distant metastasis, NOS
+ Carcinomatosis
+ Distant metastasis WITH or WITHOUT distant lymph node(s) |
| 9 |
Unknown if extension or metastasis |
(1) Fritz AG, Ries LAG (eds). **SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998)**, National Cancer Institute, NIH Pub. No. 98-2313, Bethesda, MD, 1998
(2) Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds.). **SEER Summary Staging Manual-2000: Codes and Coding Instructions**, National Cancer Institute, NIH Pub. No. 01-4969, Bethesda, MD, 2001.
(3) Collaborative Stage Work Group of the American Joint Committee on Cancer. **Collaborative Stage Data Collection System User Documentation and Coding Instructions, version 02.05.** American Joint Committee on Cancer (Chicago, IL)
(4) Gress, D.M., Edge, S.B., Gershenwald, J.E., et al. **Principles of Cancer Staging.** In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 3-30
(5) Bochner, B.H., Hansel, D.E., Stadler, W.M., et al. **Urinary Bladder**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 757-765
