THE CURRENT TNM‐CLASSIFICATION OF BLADDER CARCINOMA‐IS IT AS GOOD AS WE NEED IT TO BE?

Abstract

The TNM classification endorsed by the Inter- national Union Against Cancer (UICC) provides a dependable description and classification of the extent of malignant tumors. The aim of the TNM classifica- tion are as follows: to aid clinicians in the planning of treatment, to give some indication of prognosis, to assist in evaluation of the treatment results, to facili- tate the exchange of information between treatment centers, and to contribute to the continuing investiga- tion of human cancer.’ The TNM system consists of two distinct classifications, a pretreatment clinical staging classification and a postsurgical histo- pathological staging classification. Differences in the extent of disease between individual categories in the clinical staging classification and the histopathological staging classification are substantial. There is a con- siderable interest in improving accuracy of the clinical assessment of the extent of the disease which would minimize these differences. In a clinical staging of bladder cancer, improvements in imaging would be valued. A reliable clinical staging classification is para- mount to the planning of treatment and to indication of prognosis. Ideally, the staging system should be supported by an international consensus and require availability of simple and accurate diagnostic procedures. The TNM Groups of the last three International Consen- sus Meetings on Bladder Cancer have attempted to reach a consensus on the classification of bladder cancer using the TNM system, first in Antwerp in 1985,5 second in Hakone in 1987,6 and third in