Note: The American Joint Committee on Cancer has recently published a new edition of the AJCC Cancer Staging Manual, which includes revisions to the staging for this disease. The PDQ Adult Treatment Editorial Board, which is responsible for maintaining this summary, is currently reviewing the new staging to determine the changes that need to be made in the summary. In addition to updating this Stage Information section, additional changes may need to be made to other parts of this summary to ensure that it is up-to-date. The changes will be made as soon as possible.
Though comparable in many respects to staging systems described for bladder cancer, unique structural aspects of the renal pelvis and ureter have led to several differences in the classification schema of tumors that involve the upper tracts. Clinical staging is based on a combination of radiographic procedures (e.g., intravenous pyelogram and computed tomographic scans) and, more recently, ureteroscopy and biopsy.
For more information from the National Cancer Institute about transitional cell cancer of the renal pelvis and ureter, see the following:
Transitional Cell Cancer (Kidney/Ureter) Home Page
Smoking Home Page (Includes help with quitting)
For general cancer information and other resources from the National Cancer Institute, see the following:
What You Need to Know About™ Cancer
Understanding Cancer Series: Cancer
Chemotherapy and You: Support for People With...
The advent of rigid and flexible ureteroscopic techniques has permitted endoscopic access to the ureter and renal pelvis. This may permit greater accuracy in preoperative definition of the stage and grade of an upper tract neoplasm. In addition, fulguration and endourological access permit resection or laser coagulation of highly selected low-stage, low-grade lesions of the ureters. However, this approach is still under clinical evaluation since there is the possibility of inaccurate assessment of the stage and extent of disease, and the adequacy and risks of such treatment have not yet been defined.[2,3,4,5]
Because of the inaccessibility of ureteral and pelvic anatomy, accurate staging requires pathologic analysis of the surgically excised specimen.
The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define carcinoma of the renal pelvis and ureter.
Primary tumor (T)
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Ta: Papillary noninvasive carcinoma
Tis: Carcinoma in situ
T1: Tumor invades subepithelial connective tissue
T2: Tumor invades the muscularis
T3: (For renal pelvis only) Tumor invades beyond muscularis into peripelvic fat or the renal parenchyma