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Grading and staging is made at cystoscopy. Any visible tumour is resected. This is sent for histology to grade the tumour. The bladder is then washed out. A bimanual examination is performed to determine the clinical stage. A further deep biopsy is taken. This is sent for histology to determine the pathological stage.
Grading is either:
Staging is by the TNM system. A T prefix denotes the stage as assessed clinically. A p prefix is added when the clinical findings are supported by pathological analysis.
Pathological stages pT3 and pT4 can only be made on bladder specimens after total or partial cystectomy.
Upper urinary tract tumours can only be staged from surgically excised specimens.
Nodal and metastatic spread is assessed only when radiotherapy or radical surgery is contemplated.