How are transitional cell carcinomas (TCCs) staged?

Updated: Mar 18, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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The American Joint Committee on Cancer (AJCC) designates stages in the tumor, nodes, metastases (TNM) system. Stages are based on the depth of tumoral invasion, as follows:

  • Ta - papillary noninvasive carcinoma

  • Tis - carcinoma in situ

  • T1 - invasion of the subepithelial connective tissue

  • T2 - invasion of the muscularis propria

  • T3 - invasion beyond the muscularis into the periureteric fat (ureter only), the peripelvic fat (renal pelvis only), or the renal parenchyma

  • T4 - invasion of adjacent organs or through the kidney into the perinephric fat

N0 indicates no regional lymph node metastasis; N1, metastasis in a single lymph node 2 cm in diameter or smaller; N2, metastasis in a single lymph node 2-5 cm in diameter or multiple lymph nodes, none larger than 5 cm in diameter; and N3, metastasis in a lymph node larger than 5 cm in diameter.

M0 indicates no distant metastasis, and M1, distant metastasis.

Therefore, the AJCC defines the stages as follows:

  • Stage 0, localized disease with Ta or Tis/N0/M0

  • Stage I, mucosal lamina propria involved with T1/N0/M0

  • Stage II, disease into but not beyond the muscularis with T2/N0/M0

  • Stage III, invasion of the renal parenchyma and/or fat with T3/N0/M0

  • Stage IV, metastases with T4/N0/M0, any T/N1-3/M0, or any T/any N/M1

Hydronephrosis on preoperative axial CT at the time of diagnosis of upper-tract urothelial carcinoma is associated with advanced-stage cancer and is a predictor of poorer outcomes. Hydronephrosis can be a valuable prognostic tool for preoperative planning and counseling regarding disease outcomes. [20]

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