Clinical T

This input is used for staging


**Note 1:** If pTa is assigned, then Behavior ICD-O-3 must be 2. **Note 2:** The two main types of bladder cancer are the flat (sessile) variety and the papillary type. * 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 cell 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 (see also Note 4 if tumor is not described as papillary) **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 (Tis) If the tumor has penetrated the basement membrane to invade the lamina propria: then it is invasive (T1) 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" (Tis) 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:** In case of multifocal noninvasive Ta and Tis tumors, assign Tis. **Note 6:** Assign T1 when there is extension from the bladder into the subepithelial tissue of prostatic urethra. **Note 7:** Assign T2 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. If there is documentation that tumor has breached the wall, including invasion into fat or beyond, assign T3 or higher. **Note 8:** An associated in situ component of tumor extending into the prostatic ducts, prostatic glands, or ureter without invasion is disregarded in staging classification. Assign the T that best describes depth of bladder wall invasion. **Note 9:** Assign T1 or T2 as appropriate for extension from bladder directly into distal ureter. Direct invasion of the distal ureter is classified by the depth of greatest invasion in the bladder or ureter for TNM staging. The distal ureter is defined as below the iliac vessel, within the pelvic brim. **Note 10:** A cystectomy must be done to assign pathologic T. If only a TURB is done, this is a clinical T.


Clinical T Clinical T Display Description Registrar Notes
cX cTX Primary tumor cannot be assessed Clinical classification criteria met, evaluation done:
Physician unable to assess T
Extension cannot be determined
Physician assigns cTX, no other information available to determine T
c0 cT0 No evidence of primary tumor
pA pTa Non-invasive papillary carcinoma Papillary:
Papillary transitional cell carcinoma, stated to be noninvasive
Papillary non-infiltrating
Papillary transitional cell carcinoma, with inferred description of noninvasion
(see Notes 2 and 3)

Stated as Ta
pIS pTis Carcinoma in situ: "flat tumor" Nonpapillary:
Sessile (flat) (solid) carcinoma in situ
Carcinoma in situ, NOS
Transitional cell carcinoma in situ

Confined to mucosa, NOS (see Note 4)

Stated as Tis
c1 cT1 Tumor invades subepithelial connective tissue Subepithelial connective tissue
Lamina propria
Tunica propria
Prostatic urethra

Extension to distal ureter:
Subepithelial connective tissue of bladder and/or distal ureter (see Note 9)

Localized, NOS

Stated as T1
c2 cT2 Tumor invades muscle Note: T2 has subcategories of T2a (tumor invades superficial muscle (inner half)) and T2b (tumor invades deep muscle (outer half)) but these would be rarely specified for the clinical assessment. Therefore, cT2a and cT2b should be assigned to cT2

Muscle (muscularis propria) invaded, NOS of bladder only

Extension to distal ureter:
Muscle (muscularis propria) invaded, NOS of bladder and/or distal ureter (see Note 9)

Stated as T2 [NOS]
c3 cT3 Tumor invades perivesical tissue Note: T3 has subcategories of T3a (tumor invades perivesical tissue (microscopically)) and T3b (tumor invades perivesical tissue (macroscopically)) but these would be rarely specified for the clinical assessment. Therefore, cT3a and cT3b should be assigned to cT3

Extension to perivesical fat/tissues, NOS, including:
Serosa (mesothelium)
Periprostatic tissue
Distal periureteral tissue

Stated as T3 [NOS]
c4 cT4 Tumor invades any of the following:
Prostate stroma
Seminal vesicles
Pelvic wall
Abdominal wall
Note: T4 has subcategories of T4a and T4b. Assign T4 only when there is no information available to assign one of the subcategories

Stated as T4 [NOS]
c4A cT4a Tumor invades:
Prostate stroma
Seminal vesicles
Extension to:
Prostate, NOS
Rectovesical/Denonvilliers' fascia
Small intestine
Ureter (excluding distal ureter)
Urethra, including prostatic urethra (excluding subepithelial connective tissue) (see T1/Note 6)
Vas deferens

Stated as T4a
c4B cT4b Tumor invades pelvic wall or abdominal wall Bladder is "fixed"

Extension to:
Pubic bone

Further contiguous extension

Stated as T4b
88 88 Not applicable Primary site/histology not TNM defined
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Clinical classification criteria not met
Clinical classification criteria met, evaluation done:
No information about diagnostic workup
Results not documented in record
Clinical evaluation of primary tumor not done or unknown if done
Tumor first detected on surgical resection (no clinical workup)
Evidence of metastatic disease [(cM1) or (pM1)], no other workup
Only Clinical Stage Group documented (no T, N, or M information available)