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Stage Information for Transitional Cell Cancer of the Renal Pelvis and Ureter

    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.

    Table 4. Anatomic Stage/ Prognostic Groupsa

    StageTNM
    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.
    0aTaN0M0
    0isTisN0M0
    IT1N0M0
    IIT2N0M0
    IIIT3N0M0
    IVT4N0M0
    Any TN1M0
    Any TN2M0
    Any TN3M0
    Any TAny NM1

    Patients may also be designated as having localized, regional, or metastatic disease, as follows:

    Localized

    Patients with localized disease may be classified into three groups:

    • Group 1: Low-grade tumor confined to the urothelium without lamina propria invasion ("Papilloma" Grade I transitional cell cancer).
    • Group 2: Grade I–III carcinomas without demonstrable subepithelial invasion or focal microscopic invasion or papillary carcinomas with carcinoma in situ and/or carcinoma in situ elsewhere in the urothelium.
    • Group 3: High-grade tumors that have infiltrated the renal pelvic wall or renal parenchyma or both but are still confined to the kidney. Infiltration of muscle in the upper tract may not be associated with as much potential for distant dissemination as appears to be the case for bladder cancer.

    Regional

    • Group 4: Extension of tumors beyond the renal pelvis or parenchyma and invasion of peripelvic and perirenal fat, lymph nodes, hilar vessels, and adjacent tissues.

    Metastatic

    • Spread of the tumor to distant tissues.

    Each of these classifications has been subclassified into categories of unicentricity or multicentricity. The latter category indicates a more pervasive tumor diathesis and generally a less favorable prognosis.

    Although the classifications listed above have prognostic significance, they can only be determined at the time of nephroureterectomy, which is the treatment of choice for patients with this disease. Because of the high incidence of tumor recurrence within the intramural ureter among patients who have had incomplete excision of this area, nephroureterectomy should include the entire ureter and a margin of periureteral orifice mucosa (i.e., bladder cuff).

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