Contemporary management of upper tract urothelial cell carcinoma

Table 1 TNM classification

T - primary tumor
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
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
M0	No distant metastasis
M1	Distant metastasis

NCCN Guidelines^® version 2, 2015[19]. Upper GU tract tumors.

Table 2 Adjuvant treatment for renal pelvis and urothelial carcinoma of ureter

Pathologic staging	Adjuvant treatment	Follow-up
pT0, pT1	None	Cystoscopy every 3 mo for 1 yr, then at increasing intervals Imaging of upper tract collecting system at 3- to 12-mo intervals, if endoscopic resection ± CT scan or MRI ± Chest X-ray
pT2, pT3 pT4, pN+	Consider adjuvant chemotherapy	Cystoscopy every 3 mo for 1 yr, then at increasing intervals Imaging of upper tract collecting system at 3- to 12-mo intervals ± CT scan or MRI ± Chest X-ray

NCCN Guidelines^® version 2, 2015[19]. Upper GU tract tumors. CT: Computed tomography; MRI: Magnetic resonance imaging.