How are urothelial tumors of the renal pelvis and ureters staged?

Updated: Aug 07, 2020
  • Author: Kyle A Richards, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The distribution of tumor stages and grades differs from study to study. Stage and grade yield the greatest prognostic value.

The National Comprehensive Cancer Network (NCCN) guidelines grade urothelial histologies according to the World Health Organization (WHO)/International Society of Urological Pathology (ISUP) classification as follows [23] :

  • Low-grade 
  • High-grade 

Squamous cell carcinoma and adenocarcinoma use the following grading classifications [23] :

  • GX—Grade cannot be assessed
  • G1—Well differentiated
  • G2—Moderately differentiated
  • G3—Poorly differentiated 

Staging is based on the depth of tumor invasion and classified using the tumor, node, metastases (TNM) system. [24]  

Primary tumor categories are as follows:

  • TX - Primary tumor cannot be assessedT0 - No evidence of primary tumor
  • Ta - Papillary noninvasive carcinoma
  • Tis - Carcinoma in situ
  • T1 - Subepithelial connnective tissue invasion
  • T2 - Muscularis invasion
  • 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
  • T4 - Tumor invades adjacent organs, or through the kidney into the perinephric fat 

Regional lymph node categories are as follows:

  • NX - Regional lymph nodes cannot be assessed
  • N0 - Negative nodes
  • N1 - Metastasis ≤2 cm in greatest dimension in a single lymph node
  • N2 - Metastasis  > 2 cm in a single lymph node, or multiple lymph nodes

Distant metastasis categories are as follows:

  • M0 - No distant metastasis
  • M1 - Distant metastasis

The location of the tumor can affect the findings. Renal pelvis tumors are more commonly invasive than bladder tumors, possibly because of delayed diagnosis and a less well-developed muscle layer.

Table 1. American Joint Committee on Cancer Prognostic Groups (Open Table in a new window)

Stage

Tumor

Node

Metastasis

0a

Ta

N0

M0

0is

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

IV

T4

NX, N0

M0

Any T

N1

M0

Any T

N2

M0

Any T

Any N

M1


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