Diagnostic Imaging Pathways - Bladder Cancer (Staging)

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This pathway provides a diagnostic imaging algorithm for staging of patients with bladder cancer on histology.

Date reviewed: January 2012

Date of next review: January 2015

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1a Papillary TCC

Papillary TCC

Images 1a & 1b: 77yo M had an incidental bladder mass detected on CT abdomen. Patient underwent TURBT & pathology confirmed low grade papillary TCC with no evidence of stromal invasion. Stage: T2N0M0.

1b Papillary TCC
2a Invasive TCC

Invasive TCC

Images 2a & 2b: 66yo F with history of recurrent TCC of bladder & left ureter. Follow-up CT shows left-sided posterolateral bladder tumour invading into adjacent ileum. No lymphadenopathy or distant metastatic disease was seen. Stage: T4N0M0.

2b Invasive TCC
3a Squamous TCC

Squamous TCC

Images 3a & 3b: 91yo M presented with frank haematuria. CT urograph showed a bladder with thickened walls and bilateral diverticulae. The larger right diverticulum had nodular wall thickening of its lateral wall. The patient later underwent open diverticulectomy. Pathological findings were of TCC with squamous differentiation. Stage: T3N0M0.

3b Squamous TCC
4a Metastatic TCC

Metastatic TCC

Images 4a & 4b: 60yo M presented with left hip pain, with initial plain films showing a mixed lytic-sclerotic lesion of his left femur & pelvis. CT abdo/pelvis showed multiple large calcific tumours within the bladder, obstructing the left ureter & causing hydronephrosis. There was a large metastatic deposit involving the left hemipelvis and acetabulum. Pathological findings showed high grade TCC with squamous differentiation. Stage: T4N0M1.

4b Metastatic TCC

Teaching Points

Teaching Points

  • Accurate staging of bladder cancer allows for optimal treatment and prognostication of the individual patient. It is important to differentiate between non-muscle-invasive lesions and muscle invasive bladder lesions.
  • Conventional rigid cystoscopy is the gold standard for diagnosis of bladder tumours, followed closely by flexible cystoscopy. Though small biopsies may be retrieved via a flexible cystoscope, rigid cystoscopy allows for tissue biopsy and formal tumour resection. Tissue histopathology provides further tumour staging information.
  • Radiologic investigations are used in bladder cancer staging for further clarifying the extent of local disease and looking for nodal & metastatic spread.
  • Distant metastatic spread is rarely seen at time of presentation. The most common sites of spread can be investigated appropriately using chest radiography (and/or CT chest) and CT abdomen.



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