Transitional cell carcinoma staging
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]
Overview
The staging of transitional cell carcinoma is based on the TNM staging system.
Staging
- Clinical staging is based on a combination of radiographic procedures (e.g., intravenous pyelogram and computed tomographic scans) and, more recently, ureteroscopy and biopsy.[1]
- 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 urinary tract neoplasm.
- 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:
T: Primary Tumor
| T | Description |
|---|---|
| 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 T3. (For ureter only) Tumor invades beyond muscularis into periureteric fat |
| T4 | Tumor invades adjacent organs, or through the kidney into the perinephric fat |
N:Regional Lymph Nodes
| N | Description |
|---|---|
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in a single lymph node, ≤2 cm in greatest dimension |
| N2 | Metastasis in a single lymph node, >2 cm but not >5 cm in greatest dimension; or multiple lymph nodes, none >5 cm in greatest dimension |
| N3 | Metastasis in a lymph node, >5 cm in greatest dimension |
M: Distant Metastasis
| T | Description |
| M0 | There is no evidence of distant metastasis |
| M1 | There is evidence of distant metastasis |
TNM Classification
| Stage | T | N | M |
| Stage 0a | Ta | N0 | M0 |
| Stage 0is | Tis | N0 | M0 |
| Stage I | T1 | N0 | M0 |
| Stage II | T2 | N0 | M0 |
| Stage III | T3 | N0 | M0 |
| Stage IV | T4 | N0 | M0 |
| Any T | N1 | M0 | |
| Any T | N2 | M0 | |
| Any T | N3 | M0 | |
| Any T | Any N | M1 |
References
- ↑ Transitional cell cancer. National cancer institute. http://www.cancer.gov/types/kidney/hp/transitional-cell-treatment-pdq#section/_1