Urothelial Tumors of the Renal Pelvis and Ureters Workup

  • Author: Daniel M Kaplon, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Oct 27, 2011
 

Laboratory Studies

  • Urinalysis - To confirm hematuria and to rule out a coexistent urinary tract infection
  • Basic metabolic panel - To check serum creatinine (assess renal function) and electrolytes
  • Activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR) - To check baseline coagulation status
Next

Imaging Studies

  • Excretory urography
    • This test is commonly referred to as an intravenous pyelography (IVP). IVP and cystoscopy comprise the standard workup in a patient who presents with microscopic or gross hematuria. IVP is used to evaluate the upper urothelial tract, and cystoscopy is used to evaluate the lower urinary system (ie, bladder).
    • Approximately 50-75% of patients with urothelial tumors of the renal pelvis and ureters have a radiolucent filling defect that is characteristically irregular and in continuity with the wall of the collecting system. Intravenous pyelogram (IVP) demonstrating an upperIntravenous pyelogram (IVP) demonstrating an upper calyx filling defect characteristic of transitional cell carcinoma (TCC). Blunting of the involved calyx is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
    • Approximately 10-30% of such tumors cause obstruction or nonvisualization of the collecting system.
  • CT scanning
    • Noncontrast CT scanning can be performed, followed by a contrast study. CT urography with digital reconstruction has replaced IVP at some institutions. Plain radiography, which demonstrates drainage and anatomy, can also be performed after CT scanning.
    • Transitional cell carcinomas (TCCs) are usually present as an irregular filling defect. They tend to be hypovascular when compared to the rest of the kidney and demonstrate minimal increased density (enhancement) following intravenous contrast injection. CT scan demonstrating right renal pelvis transitioCT scan demonstrating right renal pelvis transitional cell carcinoma (TCC). Contrast in the renal pelvis is displaced by the tumor. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School. CT scan demonstrating left distal ureteral transitCT scan demonstrating left distal ureteral transitional cell carcinoma (TCC). The left ureter is dilated and a medial filling defect is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
    • CT scanning has limited value in staging TCC because stage Ta and T2 cannot be differentiated (see Staging). However, CT scanning is helpful in demonstrating peripelvic or periureteral tumor extension, thereby assisting with staging of aggressive disease. Hydronephrosis and obstruction are associated with a higher degree of invasiveness.
  • As with CT scanning, MRI is also of limited use in staging early TCC; however, it may have greater utility in more advanced disease.
Previous
Next

Other Tests

  • Cytopathology
    • Cytopathology of voided urine samples yield low sensitivity, especially for low-grade tumors, which result in normal cytology results in up to 80% of cases.
    • The sensitivity of cytopathology increases for higher-grade tumors, which tend to shed more tumor cells. Cytology yields an accuracy of 83% in patients with grade IV disease.
    • Selective washings of both the upper tracts and the bladder can aid in tumor localization. Cytology plays a role in urothelial tumor surveillance in conjunction with cystoscopy/ureteroscopy.
Previous
Next

Diagnostic Procedures

  • Cystoscopy
    • Cystoscopy is a procedure in which a small fiberoptic scope is inserted through the urethra in order to visualize the bladder. This ambulatory/clinical procedure is usually well tolerated by both women and men. A 16F flexible cystoscope is typically used in men, whereas women can undergo either rigid or flexible cystoscopic examination.
    • This procedure is mandatory to rule out coexistent bladder lesions.
    • Cystoscopy is also essential for postoperative surveillance to monitor for bladder tumor development.
  • Retrograde urography
    • Retrograde urography is a procedure in which contrast is injected into the ureteral orifice with the aid of a cystoscope. This can be performed with fluoroscopic guidance or with standard radiography plates. Left retrograde ureterogram demonstrating the clasLeft retrograde ureterogram demonstrating the classic "goblet" sign of ureteral transitional cell carcinoma (TCC). Ureteral dilation distally and proximally to the tumor is present. The narrowed wall of the ureter is irregular. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
    • Retrograde urography allows better visualization of the collecting system than excretory urography by increasing the distention of the urinary collecting system. Retrograde pyelography is preferable in patients with azotemia and/or contrast allergy.
    • Overall, retrograde urography is more than 75% accurate in establishing a diagnosis of urothelial cancer.
  • Ureteropyeloscopy
    • Since the advent of rigid and flexible ureteroscopes, ureteropyeloscopy is used increasingly for the diagnosis of upper tract urothelial tumors.
    • Biopsy forceps or cytology brushings can be used to collect tissue.
    • This procedure yields an accuracy of 86% in diagnosing renal pelvis tumors and 90% in diagnosing ureteral tumors. Large size, broad base, and nonpapillary pattern favor tumor invasiveness. Studies have demonstrated that 85% of TCC lesions in the renal pelvis are papillary.
    • The complication rate associated with ureteropyeloscopy is approximately 7%, including perforation, complete disruption, and ureteral stricture.
  • Percutaneous nephroscopy is not indicated for the diagnosis of urothelial tumors of the renal pelvis and ureters because of the theoretical risk of tumor cell implantation in the retroperitoneum and nephrostomy tube tract.
Previous
Next

Staging

The distribution of tumor stages and grades differs from study to study. Most urothelial tumors of the renal pelvis and ureters are low-grade, low-stage TCCs. Stage and grade yield the greatest prognostic value.

Grading (I-IV): Pathological assignments range from grade 1 for well-differentiated tumors to grade 4 for poorly differentiated tumors. In one study, almost 60% of tumors were grade I or II, and 70% of tumors were stage Tis/Ta through T2 (see below).

Staging: Stages are based on the depth of tumor invasion and are classified using the tumor, node, metastases (TNM) system. In a 1998 study, stage I disease was found in 96% of patients with grade I upper tract TCC.[6]

  • Tis - Carcinoma in situ
  • Ta - Superficial/papillary
  • T1 - Lamina propria invasion
  • T2 - Muscularis propria invasion
  • T3 - Peripelvic/periureteral/renal invasion
  • T4 - Contiguous organ involvement
  • N0 - Negative nodes
  • N1 - Metastasis in single node less than 2 cm in diameter
  • N2 - Metastasis in single node 2-5 cm in diameter or metastasis to multiple nodes less than 5 cm in diameter
  • N3 - Metastasis in lymph node greater than 5 cm in diameter
  • M0 - No distant metastasis
  • M1 - Distant metastasis

The location of the tumor can affect the findings. Renal pelvis tumors are more commonly invasive than bladder tumors, possibly because of delayed diagnosis and a less well-developed muscle layer.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Daniel M Kaplon, MD  Fellow in Endourology, Laparoscopy, and Robotics, Department of Urology, University of Wisconsin Medical School

Daniel M Kaplon, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

David F Jarrard, MD  Professor of Urology and Molecular and Environmental Toxicology, University of Wisconsin School of Medicine and Public Health

David F Jarrard, MD is a member of the following medical societies: American Urological Association

Disclosure: Johnson and Johnson Consulting fee Consulting

John N Papadopoulos, MD  Staff Physician, Department of Urology, Veterans Administration Hospital and Meriter Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Gabriel Gomella, MD, FACS  The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology

Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dan Theodorescu, MD, PhD  Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center

Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology

Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Michael N Wilkin, MD, to the development and writing of this article.

References

  1. Raman JD, Scherr DS. Management of patients with upper urinary tract transitional cell carcinoma. Nat Clin Pract Urol. Aug 2007;4(8):432-43. [Medline].

  2. Rouprêt M, Fromont G, Azzouzi AR, Catto JW, Vallancien G, Hamdy FC, et al. Microsatellite instability as predictor of survival in patients with invasive upper urinary tract transitional cell carcinoma. Urology. Jun 2005;65(6):1233-7. [Medline].

  3. Roupret M, Catto J, Coulet F, Azzouzi AR, Amira N, Karmouni T, et al. Microsatellite instability as indicator of MSH2 gene mutation in patients with upper urinary tract transitional cell carcinoma. J Med Genet. Jul 2004;41(7):e91. [Medline].

  4. Smith SD, Wheeler MA, Plescia J, Colberg JW, Weiss RM, Altieri DC. Urine detection of survivin and diagnosis of bladder cancer. JAMA. Jan 17 2001;285(3):324-8. [Medline].

  5. Sarosdy MF, Kahn PR, Ziffer MD, Love WR, Barkin J, Abara EO. Use of a multitarget fluorescence in situ hybridization assay to diagnose bladder cancer in patients with hematuria. J Urol. Jul 2006;176(1):44-7. [Medline].

  6. Hall MC, Womack S, Sagalowsky AI. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. Oct 1998;52(4):594-601. [Medline].

  7. Keeley FX Jr, Bagley DH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol. Dec 1997;158(6):2074-7. [Medline].

  8. O'Brien T, Ray E, Singh R, Coker B, Beard R. Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol. Oct 2011;60(4):703-10. [Medline].

  9. See WA. Continuous antegrade infusion of adriamycin as adjuvant therapy for upper tract urothelial malignancies. Urology. Aug 1 2000;56(2):216-22. [Medline].

  10. Waldert M, Remzi M, Klingler HC, Mueller L, Marberger M. The oncological results of laparoscopic nephroureterectomy for upper urinary tract transitional cell cancer are equal to those of open nephroureterectomy. BJU Int. Jan 2009;103(1):66-70. [Medline].

  11. Krambeck AE, Thompson RH, Lohse CM, Patterson DE, Segura JW, Zincke H, et al. Endoscopic management of upper tract urothelial carcinoma in patients with a history of bladder urothelial carcinoma. J Urol. May 2007;177(5):1721-6. [Medline].

  12. Nakada SY, Pearle MS. Advanced Endourology: The Complete Clinical Guide. Humana Press; 2005:277-8.

  13. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol. Oct 2007;178(4 Pt 1):1212-7; discussion 1217. [Medline].

  14. Chen GL, El-Gabry EA, Bagley DH. Surveillance of upper urinary tract transitional cell carcinoma: the role of ureteroscopy, retrograde pyelography, cytology and urinalysis. J Urol. Dec 2000;164(6):1901-4. [Medline].

  15. Siemens DR, Morales A, Johnston B, Emerson L. A comparative analysis of rapid urine tests for the diagnosis of upper urinary tract malignancy. Can J Urol. Feb 2003;10(1):1754-8. [Medline].

  16. Chen GL, Bagley DH. Ureteroscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. J Urol. Oct 2000;164(4):1173-6. [Medline].

  17. Chromecki TF, Ehdaie B, Novara G, et al. Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy. World J Urol. Aug 2011;29(4):473-80. [Medline].

  18. Ehdaie B, Chromecki TF, Lee RK, et al. Obesity adversely impacts disease specific outcomes in patients with upper tract urothelial carcinoma. J Urol. Jul 2011;186(1):66-72. [Medline].

  19. Anderstrom C, Johansson SL, Pettersson S. Carcinoma of the ureter: a clinicopathologic study of 49 cases. J Urol. Aug 1989;142(2 Pt 1):280-3. [Medline].

  20. Babaian RJ, Johnson DE. Primary carcinoma of the ureter. J Urol. Mar 1980;123(3):357-9. [Medline].

  21. Bagley DH. Ureteroscopic treatment of upper urinary tract neoplasms. In: Smith AD, ed. Smith's Textbook of Endourology. ed. St. Louis, Mo: Quality Medical Publishing; 1996:474.

  22. Batata MA, Whitmore WF, Hilaris BS. Primary carcinoma of the ureter: a prognostic study. Cancer. Jun 1975;35(6):1626-32. [Medline].

  23. Bazeed MA, Scharfe T, Becht E. Local excision of urothelial cancer of the upper urinary tract. Eur Urol. 1986;12(2):89-95. [Medline].

  24. Bellman GC, Sweetser P, Smith AD. Complications of intracavitary bacillus Calmette-Guerin after percutaneous resection of upper tract transitional cell carcinoma. J Urol. Jan 1994;151(1):13-5. [Medline].

  25. Bloom NA, Vidone RA, Lytton B. Primary carcinoma of the ureter: a report of 102 new cases. J Urol. May 1970;103(5):590-8. [Medline].

  26. Blute ML, Segura JW, Patterson DE. Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer. J Urol. Jun 1989;141(6):1298-301. [Medline].

  27. Boorjian S, Ng C, Munver R, Palese MA, Vaughan ED Jr, Sosa RE. Impact of delay to nephroureterectomy for patients undergoing ureteroscopic biopsy and laser tumor ablation of upper tract transitional cell carcinoma. Urology. Aug 2005;66(2):283-7. [Medline].

  28. Brown JA, Strup SE, Chenven E, Bagley D, Gomella LG. Hand-assisted laparoscopic nephroureterectomy: analysis of distal ureterectomy technique, margin status, and surgical outcomes. Urology. Dec 2005;66(6):1192-6. [Medline].

  29. Cairns P, Proctor AJ, Knowles MA. Loss of heterozygosity at the RB locus is frequent and correlates with muscle invasion in bladder carcinoma. Oncogene. Dec 1991;6(12):2305-9. [Medline].

  30. Chahal R, Taylor K, Eardley I, Lloyd SN, Spencer JA. Patients at high risk for upper tract urothelial cancer: evaluation of hydronephrosis using high resolution magnetic resonance urography. J Urol. Aug 2005;174(2):478-82; quiz 801. [Medline].

  31. Cordon-Cardo C, Zhang ZF, Dalbagni G, Drobnjak M, Charytonowicz E, Hu SX, et al. Cooperative effects of p53 and pRB alterations in primary superficial bladder tumors. Cancer Res. Apr 1 1997;57(7):1217-21. [Medline].

  32. Cote RJ, Dunn MD, Chatterjee SJ, Stein JP, Shi SR, Tran QC, et al. Elevated and absent pRb expression is associated with bladder cancer progression and has cooperative effects with p53. Cancer Res. Mar 15 1998;58(6):1090-4. [Medline].

  33. Czerniak B, Chaturvedi V, Li L, Hodges S, Johnston D, Roy JY, et al. Superimposed histologic and genetic mapping of chromosome 9 in progression of human urinary bladder neoplasia: implications for a genetic model of multistep urothelial carcinogenesis and early detection of urinary bladder cancer. Oncogene. Feb 4 1999;18(5):1185-96. [Medline].

  34. Czito B, Zietman A, Kaufman D, Skowronski U, Shipley W. Adjuvant radiotherapy with and without concurrent chemotherapy for locally advanced transitional cell carcinoma of the renal pelvis and ureter. J Urol. Oct 2004;172(4 Pt 1):1271-5. [Medline].

  35. Eastham JA, Huffman JL. Technique of mitomycin C instillation in the treatment of upper urinary tract urothelial tumors. J Urol. Aug 1993;150(2 Pt 1):324-5. [Medline].

  36. Grace DA, Taylor WN, Taylor JN. Carcinoma of the renal pelvis: a 15-year review. J Urol. Nov 1967;98(5):566-9. [Medline].

  37. Greenland JE, Weston PM, Wallace DM. Familial transitional cell carcinoma and the Lynch syndrome II. Br J Urol. Aug 1993;72(2):177-80. [Medline].

  38. Grossman HB, Schwartz SL, Konnak JW. Ureteroscopic treatment of urothelial carcinoma of the ureter and renal pelvis. J Urol. Aug 1992;148(2 Pt 1):275-7. [Medline].

  39. Harris CC, Hollstein M. Clinical implications of the p53 tumor-suppressor gene. N Engl J Med. Oct 28 1993;329(18):1318-27. [Medline].

  40. Huang A, Low RK, deVere White R. Nephrostomy tract tumor seeding following percutaneous manipulation of a ureteral carcinoma. J Urol. Mar 1995;153(3 Pt 2):1041-2. [Medline].

  41. Jarrett TW, Sweetser PM, Weiss GH. Percutaneous management of transitional cell carcinoma of the renal collecting system: 9-year experience. J Urol. Nov 1995;154(5):1629-35. [Medline].

  42. Jensen OM, Knudsen JB, McLaughlin JK. The Copenhagen case-control study of renal pelvis and ureter cancer: role of smoking and occupational exposures. Int J Cancer. Apr 15 1988;41(4):557-61. [Medline].

  43. Johansson S, Wahlqvist L. A prognostic study of urothelial renal pelvic tumors: comparison between the prognosis of patients treated with intrafascial nephrectomy and perifascial nephroureterectomy. Cancer. Jun 1979;43(6):2525-31. [Medline].

  44. Johnson DE, Babaian RJ. Conservative surgical management for noninvasive distal ureteral carcinoma. Urology. Apr 1979;13(4):365-7. [Medline].

  45. Keeley FX Jr, Bibbo M, Bagley DH. Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol. May 1997;157(5):1560-5. [Medline].

  46. Lantz EJ, Hattery RR. Diagnostic imaging of urothelial cancer. Urol Clin North Am. Nov 1984;11(4):567-83. [Medline].

  47. Lee BR, Jabbour ME, Marshall FF. 13-year survival comparison of percutaneous and open nephroureterectomy approaches for management of transitional cell carcinoma of renal collecting system: equivalent outcomes. J Endourol. May 1999;13(4):289-94. [Medline].

  48. Lee D, Trabulsi E, McGinnis D, et al. Totally endoscopic management of upper tract transitional-cell carcinoma. J Endourol. Feb 2002;16(1):37-41. [Medline].

  49. Mazeman E, Biserte J. Renal-sparing treatment of upper tract urothelial tumors. Curr Opin Urol. 1994;4:168-73.

  50. McCoy JG, Honda H, Reznicek M. Computerized tomography for detection and staging of localized and pathologically defined upper tract urothelial tumors. J Urol. Dec 1991;146(6):1500-3. [Medline].

  51. Messing EM, Catalona W. Urothelial tumors of the urinary tract. In: Walsh PC, Retik AB, Vaughan ED Jr et al, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:2327-410.

  52. Murphy DM, Zincke H, Furlow WL. Management of high grade transitional cell cancer of the upper urinary tract. J Urol. Jan 1981;125(1):25-9. [Medline].

  53. Murphy DM, Zincke H, Furlow WL. Primary grade 1 transitional cell carcinoma of the renal pelvis and ureter. J Urol. May 1980;123(5):629-31. [Medline].

  54. Nonomura N, Ono Y, Nozawa M, Fukui T, Harada Y, Nishimura K. Bacillus Calmette-Guérin perfusion therapy for the treatment of transitional cell carcinoma in situ of the upper urinary tract. Eur Urol. Dec 2000;38(6):701-4;discussion 705. [Medline].

  55. O'Donoghue JP, Crew JP. Adjuvant topical treatment of upper urinary tract urothelial tumours. BJU Int. Sep 2004;94(4):483-5. [Medline].

  56. Patel A, Fuchs GJ. New techniques for the administration of topical adjuvant therapy after endoscopic ablation of upper urinary tract transitional cell carcinoma. J Urol. Jan 1998;159(1):71-5. [Medline].

  57. Petkovic SD. Epidemiology and treatment of renal pelvic and ureteral tumors. J Urol. Dec 1975;114(6):858-65. [Medline].

  58. Radovanovic Z, Krajinovic S, Jankovic S. Family history of cancer among cases of upper urothelial tumours in a Balkan nephropathy area. J Cancer Res Clin Oncol. 1985;110(2):181-3. [Medline].

  59. Ramsey JC, Soloway MS. Instillation of bacillus Calmette-Guerin into the renal pelvis of a solitary kidney for the treatment of transitional cell carcinoma. J Urol. Jun 1990;143(6):1220-2. [Medline].

  60. Razdan S, Johannes J, Cox M, Bagley DH. Current practice patterns in urologic management of upper-tract transitional-cell carcinoma. J Endourol. Apr 2005;19(3):366-71. [Medline].

  61. Resseguie LJ, Nobrega FT, Farrow GM. Epidemiology of renal and ureteral cancer in Rochester, Minnesota, 1950- 1974, with special reference to clinical and pathologic features. Mayo Clin Proc. Aug 1978;53(8):503-10. [Medline].

  62. Schlegel PN. What's new in urology. J Am Coll Surg. Aug 2001;193(2):179-201. [Medline].

  63. Seaman EK, Slawin KM, Benson MC. Treatment options for upper tract transitional-cell carcinoma. Urol Clin North Am. May 1993;20(2):349-54. [Medline].

  64. Shalhav AL, Dunn MD, Portis AJ. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J Urol. 2000;163 (4):1100-1104. [Medline].

  65. Sharpe JR, Duffy G, Chin JL. Intrarenal bacillus Calmette-Guerin therapy for upper urinary tract carcinoma in situ. J Urol. Mar 1993;149(3):457-9; discussion 459-60. [Medline].

  66. Simoneau M, Aboulkassim TO, LaRue H, Rousseau F, Fradet Y. Four tumor suppressor loci on chromosome 9q in bladder cancer: evidence for two novel candidate regions at 9q22.3 and 9q31. Oncogene. Jan 7 1999;18(1):157-63. [Medline].

  67. Spires SE, Banks ER, Cibull ML. Adenocarcinoma of renal pelvis [published erratum appears in Arch Pathol Lab Med 1994 Sep;118(9):872]. Arch Pathol Lab Med. Nov 1993;117(11):1156-60. [Medline].

  68. Stein A, Sova Y, Lurie M. Adenocarcinoma of the renal pelvis. Report of two cases, one with simultaneous transitional cell carcinoma of the bladder. Urol Int. 1988;43(5):299-301. [Medline].

  69. Stower MJ, MacIver AG, Gingell JC. Inverted papilloma of the ureter with malignant change. Br J Urol. Jan 1990;65(1):13-6. [Medline].

  70. Tanagho EA. Anatomy of the Genitourinary Tract. In: Tanagho EA, McAninch JW, eds. Smith's General Urology. 15th ed. New York, NY: McGraw-Hill; 2000:4-7.

  71. Tawfiek ER, Bagley DH. Upper-tract transitional cell carcinoma. Urology. Sep 1997;50(3):321-9. [Medline].

  72. Tomera KM, Leary FJ, Zincke H. Pyeloscopy in urothelial tumors. J Urol. Jun 1982;127(6):1088-9. [Medline].

  73. Vasavada SP, Streem SB, Novick AC. Definitive tumor resection and percutaneous bacille Calmette-Guerin for management of renal pelvic transitional cell carcinoma in solitary kidneys. Urology. Mar 1995;45(3):381-6. [Medline].

  74. von der Maase H, Hansen SW, Roberts JT, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. Sep 2000;18(17):3068-77. [Medline].

 
Previous
Next
 
Intravenous pyelogram (IVP) demonstrating an upper calyx filling defect characteristic of transitional cell carcinoma (TCC). Blunting of the involved calyx is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating right renal pelvis transitional cell carcinoma (TCC). Contrast in the renal pelvis is displaced by the tumor. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating left distal ureteral transitional cell carcinoma (TCC). The left ureter is dilated and a medial filling defect is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
Left retrograde ureterogram demonstrating the classic "goblet" sign of ureteral transitional cell carcinoma (TCC). Ureteral dilation distally and proximally to the tumor is present. The narrowed wall of the ureter is irregular. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating bulky right renal pelvis transitional cell carcinoma (TCC) replacing the majority of the renal parenchyma. A pericaval lymph node metastasis is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating metastatic transitional cell carcinoma (TCC) of the right adrenal gland. A heterogeneous adrenal mass is noted adjacent to the spine. The superior portion of the right kidney is observed. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
Treatment algorithm for managing upper-tract transitional cell carcinoma (TCC).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.