STAGING OF BLADDER-CANCER

The definitive diagnosis of bladder cancer is established at cystoscop ic examination and confirmed by means of a transurethral biopsy. A car eful bimanual palpation of the bladder under anesthesia is an integral part of the initial assessment of each patient. The most important pa rt of the assessment of patients with bladder cancer is a thorough pat hologic examination of the biopsy material establishing the histologic type of tumor, histologic grade, tumor configuration, depth of invasi on of the bladder wall, and depth of the bladder wall available for as sessment. If possible, the size of the tumor and the presence of assoc iated carcinoma in situ should also be reported. Imaging studies play a smaller role in the clinical staging of bladder cancer. However, whe n initial staging procedures point to invasion of the muscularis propr ia, chest X-ray, bone scan, and computed tomography scan of the abdome n and pelvis may provide valuable information about possible metastase s. Whereas the clinical staging is essential to select and evaluate th erapy, the pathologic stage (pTNM) provides the most precise data with which to estimate prognosis and calculate end results. The pathologic assessment entails resection of the primary tumor or a biopsy adequat e to evaluate the highest pT category, removal of lymph nodes adequate to validate the absence of regional lymph node metastasis, as well as biopsy and microscopic examination for assessment of distant metastas es. Although numerous factors have an impact on the behaviour of the m alignancy, in bladder cancer the anatomic extent of disease reflected in the current staging classification remains the most powerful indica tor of outcome. (C) 1994 Wiley-Liss, Inc.