Epidemiology, Risk Factors, Pathology and Tumour Staging



Fig 9.1
(a, b) Papillary TCC of the renal pelvis and upper calyx (x) (Courtesy of A. Durlach, Pol Bouin Laboratory, University Hospital of Reims, France)



The histopathology of upper urinary tract urothelial tumours is similar to that of urothelial neoplasia of the urinary bladder (Table 9.1) [1]. The grading system used for upper tract neoplasms is also similar to that used for bladder tumours [17].


Table 9.1
Histological classification of urothelial tumours of the upper urinary tract [4]



















Benign lesions

 Urothelial papilloma and inverted papilloma (rare)

 Villous adenoma and squamous papilloma (rare)

Malignant lesions

 Urothelial (transitional cell) carcinoma

 Squamous cell carcinoma

 Adenocarcinoma

The tumour spread occurs:

1.

By direct extension into the renal parenchyma or surrounding structures

 

2.

Along the epithelial line in an antegrade or retrograde manner

 

3.

Through lymphatic channels to the para-aortic, paracaval and ipsilateral common iliac and pelvic lymph nodes

 

4.

By haematogenous route to the liver, lung and bone [4]

 



9.4 Tumour Staging


The 2010 AJCC cancer staging is the most commonly used [19] (identical to the UICC tumour classification) (Table 9.2).


Table 9.2
The 2010 AJCC staging for the renal pelvis and ureteric cancers [19]
























































Primary tumour (T)

TX
Primary tumour cannot be assessed

T0
No evidence of primary tumour

Ta
Papillary noninvasive carcinoma

Tis
Carcinoma in situ

T1
Tumour invades subepithelial connective tissue

T2
Tumour invades the muscularis

T3
 For renal only: Tumour invades beyond muscularis into peripelvic fat or the renal parenchyma

 For ureter only: Tumour invades beyond muscularis into periureteric fat

T4
Tumour invades adjacent organs or through the kidney into the perinephric fat

Regional lymph nodes (N) (laterality does not affect the N classification)

NX
Regional lymph nodes cannot be assessed

N0
No regional lymph node metastasis

NI
Metastasis in a single regional lymph node, 2 cm or less in greatest dimension

N2
Metastasis in a single regional lymph node, more than 2 cm but not more than 5 cm in greatest dimension, or multiple lymph nodes, none more than 5 cm in greatest dimension

N3
Metastasis in a regional lymph node, more than 5 cm in greatest dimension

Distant metastasis (M)

M0
No distant metastasis
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Jul 4, 2016 | Posted by in UROLOGY | Comments Off on Epidemiology, Risk Factors, Pathology and Tumour Staging

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