From: Bladder Cancer Treatment (PDQ®)
PDQ Cancer Information Summaries [Internet].
Bethesda (MD): National Cancer Institute (US); 2002-.
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Table 5. Definition of TNM Stage IVa
| Stage | TNM | Description | Illustration |
|---|---|---|---|
| IVA | T4b, N0, M0 | –T4b = Extravesical tumor invades pelvic wall, abdominal wall. |
 |
| N0 = No lymph node metastasis. | |||
| M0 = No distant metastasis. | |||
| Any T, Any N, M1a | TX = Primary tumor cannot be assessed. | ||
| T0 = No evidence of primary tumor. | |||
| –Ta = Noninvasive papillary carcinoma. | |||
| Tis = Urothelial carcinoma in situ: flat tumor. | |||
| T1 = Tumor invades lamina propria (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 soft tissue. | |||
| –pT3a = Microscopically. | |||
| –pT3b = Macroscopically (extravesical mass). | |||
| T4 = Extravesical tumor directly invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall. | |||
| –T4a = Extravesical tumor invades directly into prostatic stroma, uterus, vagina. | |||
| –T4b = Extravesical tumor invades pelvic wall, abdominal wall. | |||
| NX = Lymph nodes cannot be assessed. | |||
| N0 = No lymph node metastasis. | |||
| N1 = Single regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node). | |||
| N2 = Multiple regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node metastasis). | |||
| N3 = Lymph node metastasis to the common iliac lymph nodes. | |||
| M0 = No distant metastasis. | |||
| –M1a = Distant metastasis limited to lymph nodes beyond the common iliacs. | |||
| IVB | Any T, Any N, M1b | TX = Primary tumor cannot be assessed. | |
| T0 = No evidence of primary tumor. | |||
| –Ta = Noninvasive papillary carcinoma. | |||
| Tis = Urothelial carcinoma in situ: flat tumor. | |||
| T1 = Tumor invades lamina propria (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 soft tissue. | |||
| –pT3a = Microscopically. | |||
| –pT3b = Macroscopically (extravesical mass). | |||
| T4 = Extravesical tumor directly invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall. | |||
| –T4a = Extravesical tumor invades directly into prostatic stroma, uterus, vagina. | |||
| –T4b = Extravesical tumor invades pelvic wall, abdominal wall. | |||
| NX = Lymph nodes cannot be assessed. | |||
| N0 = No lymph node metastasis. | |||
| N1 = Single regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node). | |||
| N2 = Multiple regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node metastasis). | |||
| N3 = Lymph node metastasis to the common iliac lymph nodes. | |||
| M1b = Non-lymph node distant metastases. |
T = primary tumor; N = regional lymph node; M = distant metastasis; p = pathological.
aReprinted with permission from AJCC: Urinary bladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 757–65.