Staging of Bladder Cancer

Staging is an important step in the management of bladder cancer as it guides treatment options and surveillance protocols. Accurate staging is highly dependent on diagnostic capabilities and surgical biopsy/resection techniques. Cystoscopy is the mainstay of bladder cancer workup with urine cytology and cystoscopic enhancement serving as adjuncts to cancer detection. After tumor identification, transurethral resection is done to obtain tissue. Recently, newer resection techniques and laser energies have been used to optimize detrusor muscle in the specimen for more accurate staging. To this end, a second-look resection is still recommended in high-risk patients. An important part of clinical staging is obtaining cross-sectional imaging. Classically, CT scan has been used though there may be a role for MRI and PET scan in certain cases. Staging follows the standard TNM classification system and the most recent WHO grading system. Subsequent risk stratification is assigned based on tumor characteristics. Risk tables can provide clinicians and patients with estimates for disease recurrence and progression and further guide surveillance strategies.