Often times a CT scan, usually a CT urogram is done. Somtimes depending on the kidney function, a MR urogram, which is MRI test, can be used instead. Somtimes the urologist has to diagnose UTUC by looking into the ureter and kidney.
Retrograde pyelogram is where a urologist takes the patient to the operating roomand uses a tiny camera passed up the urethra into the bladder and up into the ureter. Then some contrast dye is injected into the ureter, which then fills up the collecting system and can demonstrate a tumor.
A simple urine sample called a urine cytology is often helpful. The pathologist looks under the microscope and tells us that these are cancerous cells that are coming from the urinary system.
It’s not a very sensitive test but it is a specific test. So see if a tumor is there then we have to use a camera and a very small scope to go and look at the ureter and the renal pelvis and try to get a biopsy.
Stage 0, or stage TA or TIS
Stage 0, or stage TA or TIS is a tumor that is just involving the mucosa, the lining on the top. This occurs in 31% of patients with upper tract urothelial carcinoma.
Stage 1 occurs in 25% of patients, and that is when the tumor not only invades the mucosa, but the lamina propria. The lamina propria is a basement membrane, and there are some lymphatics and blood supply there where the tumor, if it sits there long enough, or if it’s aggressive, may actually spread.
Stage 2 muscle-invasive upper tract urothelial carcinoma, tumors not only invade the mucosa, not only invade the lamina propria, but they also invade the muscle lining of the ureter or the renal pelvis. This occurs in 14% of patients.
Stage 3 cancers occur in 24% of patients. It involves the mucosa, the lamina propria, and the muscle. In the kidney, it can actually grow from the renal pelvis into the kidney or the fat around the renal pelvis or ureter.
Stage 4 upper tract urothelial carcinoma can involve surrounding organs or, if it spreads to lymph nodes in the lung or in the retroperitoneum, it would also be considered locally advanced or stage 4 upper tract urothelial carcinoma. This occurs in about 6% of patients.
- 35% are low grade or non-aggressive tumors
- 65% of the times are high grade or aggressive