180 The Urinary System
STAGING OF BLADDER CANCER (TCC)Stage Extent of Cancer Treatment Protocols/Options
0 cancer cells are in a single localized area in the one or a combination of
the superficial cells of the urothelium (epithelial • transurethral resection (TUR) with fulguration
cells that form the lining of the BLADDER) (cystoscopic removal of the tumor and
also called carcinoma in situ (CIS) electrocautery to the adjacent tissue)
- intravesical BCG (bacillus Calmette-Guérin instilled
into the bladder via urethral catheter) - intravesical chemotherapy (chemotherapy instilled
into the bladder via urethral catheter) - photodynamic therapy
1 tumor remains confined to the urothelium TUR with fulguration orsegmental cystectomy (partial
removal of the bladder) in combination with one or
more adjunctive therapies:
- intravesical BCG
- intravesical CHEMOTHERAPY
- radioactive seeding (implantation of radioactive
pellets) - systemic chemotherapy
2 tumor extends into but not beyond the radical cystectomy (removal of bladder and surrounding
detrusor MUSCLE organs and tissues in combination with one or more
adjunctive therapies:
- RADIATION THERAPY
- radioactive seeding
- chemotherapy
urinary diversion (urostomy, reservoir)
3 tumor extends beyond the bladder wall to preoperative chemotherapy
surrounding tissue radical cystectomy (including removal of lymph nodes
tumor may invade the PROSTATE GLAND(men) or and any other organs to which the cancer has spread)
CERVIX, UTERUS, VAGINA, or OVARIES(women) urinary diversion
postoperative radiation therapy, chemotherapy, or both
4 tumor extends into the structures of the pelvis preoperative chemotherapy
and abdomen radical cystectomy (including removal of lymph nodes
tumor may extend into adjacent lymph nodes and any other organs or structures to which the cancer
metastatic cancer may appear in sites distant has spread)
from the bladder urinary diversion
postoperative chemotherapy, radiation therapy, or both
alternatively, palliative radiation therapy to shrink the
tumors and relieve symptoms
Recurrent tumor comes back after treatment surgery, chemotherapy, radiation therapy or a
tumor may recur in the bladder or appear combination, depending on the cancer’s location and
elsewhere in the urinary tract or distant from previous treatments
the bladder