Transitional cell carcinoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The staging of transitional cell carcinoma is based on the TNM staging system.

Staging

  • 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

  1. Transitional cell cancer. National cancer institute. http://www.cancer.gov/types/kidney/hp/transitional-cell-treatment-pdq#section/_1

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