Pathologic T

This input is used for staging

Notes

**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 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: 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 T2b 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 T3a 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, T2a, T2b, 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 (partial or total) must be done to assign pathologic T. If only a TURB is done, this is a clinical T.

NAACCR Item

NAACCR #880

Pathologic T	Pathologic T Display	Description	Registrar Notes
pX	pTX	Primary tumor cannot be assessed	Pathologic classification criteria met, evaluation done: Physician unable to assess T Surgical resection of primary tumor, extension not stated Physician assigns pTX, no other information available to determine T
p0	pT0	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
p1	pT1	Tumor invades subepithelial connective tissue	Subepithelial connective tissue Bladder: Lamina propria Stroma Submucosa 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
p2	pT2	Tumor invades muscle	Note: T2 has subcategories of T2a and T2b. Assign T2 only when there is no information available to assign one of the subcategories. 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]
p2A	pT2a	Tumor invades superficial muscle (inner half)	Muscle (muscularis propria) of bladder only: Superficial muscle - inner half Extension to distal ureter: Superficial muscle of bladder and/or distal ureter (see Note 9) Stated as T2a
p2B	pT2b	Tumor invades deep muscle (outer half)	Muscle (muscularis propria) of bladder only: Deep muscle--outer half Extension through full thickness of bladder wall BUT still contained within bladder wall (see Note 7) Extension to distal ureter: Deep muscle or extension through wall of bladder and/or distal ureter (see Note 9) Stated as T2b
p3	pT3	Tumor invades perivesical tissue	Note: T3 has subcategories of T3a and T3b. Assign T3 only when there is no information available to assign one of the subcategories. Extension to perivesical fat/tissues, NOS (unknown if microscopic or macroscopic), including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Stated as T3 [NOS]
p3A	pT3a	Tumor invades perivesical tissue: microscopically	Extension to perivesical fat/tissues (microscopic) including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Stated as T3a
p3B	pT3b	Tumor invades perivesical tissue: macroscopically (extravesical mass)	Extension to perivesical fat/tissues (macroscopic) including: Adventitia Serosa (mesothelium) Peritoneum Periprostatic tissue Distal periureteral tissue Extravesical mass Stated as T3b
p4	pT4	Tumor invades any of the following: Prostate stroma Seminal vesicles Uterus Vagina 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]
p4A	pT4a	Tumor invades: Prostate stroma Seminal vesicles Uterus Vagina	Extension to: Parametrium Prostate, NOS Rectovesical/Denonvilliers' fascia Rectum Small intestine Ureter (excluding distal ureter) Urethra, including prostatic urethra (excluding subepithelial connective tissue) Vas deferens Stated as T4a
p4B	pT4b	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	Pathologic classification criteria not met Pathologic classification criteria met, evaluation done: Results not documented in patient record No surgical resection of known primary tumor (not T0) Resection insufficient for site-specific pathologic assessment No surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category Evidence of metastatic disease (pM1), no other workup Only Pathologic Stage Group documented (no T, N, or M information available)