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Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Transitional Cell Cancer of the Renal Pelvis and Ureter

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.

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.[1] 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.

Definitions of TNM

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define carcinoma of the renal pelvis and ureter.[6]

Table 1. Primary Tumor (T)a

a Reprinted with permission from AJCC: Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 491-6.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TaPapillary noninvasive carcinoma.
TisCarcinomain situ.
T1Tumor invades subepithelial connective tissue.
T2Tumor invades the muscularis.
T3(For renal pelvis only) Tumor invades beyond muscularis into peripelvic fat or the renal parenchyma T3. (For ureter only) Tumor invades beyond muscularis into periureteric fat.
T4Tumor invades adjacent organs, or through the kidney into the perinephric fat.

Table 2. Regional Lymph Nodes (N)a,b

a Reprinted with permission from AJCC: Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 491-6.
b Laterality does not affect the N classification.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastasis in a single lymph node, ≤2 cm in greatest dimension.
N2Metastasis in a single lymph node, >2 cm but not >5 cm in greatest dimension; or multiple lymph nodes, none >5 cm in greatest dimension.
N3Metastasis in a lymph node, >5 cm in greatest dimension.

Table 3. Distant Metastasis (M)a

a Reprinted with permission from AJCC: Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 491-6.
M0No distant metastasis.
M1Distant metastasis.
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