Urinary Bladder Cancer Staging Form

Scanning Protocol

CT

without contrast

with contrast

MR

without contrast

with contrast

Tumor Location / Size

Number

Solitary

Multiple

Location:

Posterior wall or Trigone

Right lateral wall

Left lateral wall

Anterior wall

Dome or Superior wall

Inferior wall or Neck

cm

Please enter a number.

Non-measurable

Or, check Non-measurable.

Largest Tumor Location:

Posterior wall or Trigone

Right lateral wall

Left lateral wall

Anterior wall

Dome or Superior wall

Inferior wall or Neck

Tumor Invasion

Lamina propria (subepithelial connective tissue)

Muscularis propria

Perivesical soft tissue

Tumor invasion to adjacent organs (T4a):

Male

Prostate

Seminal vesicles

Female

Uterus

Vagina

Pelvic wall

Abdominal wall

Others

Regional Lymph Node

Single regional lymph node (N1)

Internal iliac

right

left

Obturator

right

left

External iliac

right

left

Presacral

Common iliac (N3)

right

left

Distant Metastasis

Lymph nodes beyond common iliac

Lung

Liver

Adrenal

Bone

Others

Others

Hydronephrosis

right

left