1. TNM BLADDER CANCER STAGING Dr. Mahnaz Roayaei Radiation Oncologist Assistant Professor Isfahan University of Medical Sciences

2. AMERICAN JOINT COMMITTEE ON CANCER 2009 TNM BLADDER CANCER STAGING PRIMARY TUMOR (T) REGIONAL LYMPH NODES(N) DISTANT METASTASIS (M)

6. The primary pathologic substages of the TNM staging system such as pT2a and pT2b, cannot be determined from TURBT specimens.

7. Patients who have documented muscularis propria- invasive bladder cancer require an additional set of studies: 1.chest x-ray 2.CT scan 3.liver function studies 4.Creatinine, and electrolytes 5.Bimanual examination 6.MRI lymphangiography 7.A prostatic urethra and bulbous urethra biopsy

8. Tumor extends through the muscle to involve the full thickness of the bladder and into the serosa

9. CTS or MRI, are not reliable for staging. Only, when they show unequivocal tumor extension outside the bladder

14. Nonstromal invasive urothelial tumors of the prostate are not classified as T4, as the prognosis in this group is quite good

15. REGIONAL LYMPH NODES

17. N2 :Metastasis in multiple lymph nodes in primary drainage region

18. N3: Common iliac lymph node involvement

19. DISTANT METASTASI S (M)

20. Thanks for your attention Ref of photographs: Color Atlas by Dr.Hamid Eemami Associate Professor of Radiation Oncology Isfahan University of Medical Sciences