Σταδιοποίηση σε Ca Πυέλου & Ουρητήρων

 

Ca Νεφρικής Πυέλου & Ουρητήρων

AJCC Stages

Stages

T

N

M

0a

Ta

N0

M0

0is

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

IV

T4

N0

M0

Any T

N1

M0

Any T

N2

M0

Any T

N3

M0

Any T

Any N

M1

(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

 

Renal pelvis only

Tumor invades beyond muscularis into peripelvic fat or the renal parenchyma

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 ≤ 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

Laterality does not affect the N classification.

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Local spread

  • Intraluminal seeding of TCC to more caudal parts of ureter
    • High rate of recurrence in distal ureteral stump in patients treated with nephrectomy and incomplete ureterectomy
    • TCC rarely recurs proximal to level of resection of ureteral lesion
  • Tumors of renal pelvis tend to spread into peripelvic fat to kidney and from there to perinephric fat
    • Invasion of renal vein and inferior vena cava (IVC) can rarely occur
  • Tumors of ureter tend to invade periureteral fat to involve adjacent organs

Lymphatic extension

  • Likelihood of lymph node involvement is associated with increasing T disease
    • Ranges from 4% in noninvasive UUT TCC to as high as 60% in patients with T4 disease
  • Lymph nodes involved depend on site of primary tumor
    • Right renal pelvis → renal hilar, paracaval, and retrocaval nodes
    • Left renal pelvic → renal hilar and paraaortic nodes
    • Upper 2/3 of right ureter → retrocaval and aortocaval nodes
    • Upper 2/3 of left ureter → paraaortic nodes, nodes at origin of inferior mesenteric artery, and common iliac nodes
    • Distal 1/3 of either ureter → common iliac, internal iliac, external iliac, obturator, and presacral nodes and into lymphatics of urinary bladder

Hematogenous spread

  • Common sites for metastases include liver, lung, and bone

Κατηγοριοποίηση (Ιστολογικοί Τύποι)
  • Transitional cell carcinoma (TCC)
    • 90% of renal pelvis tumors
    • 97% of ureteric tumors
  • Adenocarcinoma

< 1% of upper urinary tract tumors
  • Squamous cell carcinoma
    • About 10% of renal pelvis tumors
    • 1% of ureteric tumors