Although grading can only be performed by histologic examination of tissue, cystoscopic findings may have some predictive value. For example, a histologically benign papilloma or a low-grade papillary tumor usually appears as a fine villous structure attached to the bladder by a thin pedicle. By contrast, a higher-grade papillary carcinoma is usually denser with a cauliflower appearance and a thicker pedicle. CIS is a fat lesion. Deeper invasion may be indicated by a nodular or sessile appearance, sometimes with necrosis. If there is tumor obstruction of the ureteric orifice, there is likely deeper infiltration.

STAGING

Staging of a bladder tumor, performed according to the 2010 TNM classification system, measures the precise extent of the tumor’s spread both within and beyond the bladder wall. It relies on information from biopsy and imaging.