Σταδιοποίηση σε Ca Ουροδόχου Κύστεως

 

Ca Ουροδόχου Κύστεως

AJCC Stages

Stages

T

N

M

0a

Ta

N0

M0

0is

Tis

N0

M0

I

T1

N0

M0

II

T2a

N0

M0

T2b

N0

M0

III

T3a

N0

M0

T3b

N0

M0

T4a

N0

M0

IV

T4b

N0

M0

Any T

N1-3

M0

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Ta

Noninvasive papillary carcinoma

Tis

Carcinoma in situ: "Flat tumor"

T1

Tumor invades subepithelial connective tissue

T2

Tumor invades muscularis propria

pT2a

Tumor invades superficial muscularis propria (inner half)

pT2b

Tumor invades deep muscularis propria (outer half)

T3

Tumor invades perivesical tissue

pT3a

Tumor invades perivesical tissue microscopically

pT3b

Tumor invades perivesical tissue macroscopically (extravesical mass)

T4

Tumor invades any of the following: Prostatic stroma, uterus, vagina, pelvic wall, abdominal wall

T4a

Tumor invades prostatic stroma, uterus, vagina

T4b

Tumor invades pelvic wall, abdominal wall

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Single regional lymph node metastasis in true pelvis (hypogastric, obturator, external iliac, or presacral lymph node)

N2

Multiple regional lymph node metastases in true pelvis (hypogastric, obturator, external iliac, or presacral lymph node)

N3

Lymph node metastasis to common iliac lymph nodes

Regional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes.

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Local spread

  • Extension through layers of bladder wall into perivesical fat
  • Invasion of local pelvic organs (Seminal vesicles, Prostate, Uterus, Ovaries, Rectum, Perineum)
  • Later spread to pelvic side wall or anterior abdominal wall

Lymphatic spread

  • Depends on depth of invasion of bladder wall
    • Superficial tumors (< T2b): Rarely spread to local nodes
    • Deep muscle invasion (T2b): 30% risk of nodal metastases
    • Perivesical extension (T3): 50-60% risk of nodal metastases
  • Initially to perivesical, presacral, and sacral nodes
  • Later to internal iliac, obturator, and external iliac nodes, and eventually to common iliac and paraaortic nodes
  • Regional lymph node metastases are those confined to true pelvis (hypogastric, obturator, external iliac, or presacral lymph node)
  • N1: Single regional lymph node
  • N2: Multiple regional lymph nodes
  • Common iliac nodes are defined as N3 disease
  • All other nodes above aortic bifurcation are considered distant metastases (M1 disease)

Hematogenous spread

  • Occurs late and with recurrent disease
  • Common sites are bones, lung, brain, and liver
    • Bone metastases occur mainly to pelvic bones and spine (perivesical venous plexus → Batson paravertebral plexus → vertebral bodies)
    • Direct extension to pelvic bones is also common

Κατηγοριοποίηση (Ιστολογικοί Τύποι)
  • Uroepithelial (95%)
    • Transitional cell carcinoma (TCC) (90%)
    • Squamous cell carcinoma (6-8%)
    • Adenocarcinoma (2%)
      • Urachal origin
      • Nonurachal origin (usually chronic irritation)
    • Neuroendocrinal (1%)
    • Mixed
  • Mesenchymal (5%) includes
    • Neurofibrosarcoma
    • Pheochromocytoma
    • Lymphoma
    • Angiosarcoma
    • Leiomyosarcoma
    • Rhabdomyosarcoma
    • Liposarcoma
    • Chondrosarcoma
    • Osteosarcoma
    • Plasmacytoma