General Information
Transitional cell carcinoma of the renal pelvis, accounting for only 7% of all
kidney tumors, and transitional cell cancer of the ureter, accounting for only
1 of every 25 upper tract tumors, are curable in more than 90% of patients if
they are superficial and confined to the renal pelvis or ureter. Patients with
deeply invasive tumors that are still confined to the renal pelvis or ureter
have a 10% to 15% likelihood of cure. Patients with tumors with penetration
through the urothelial wall or with distant metastases usually cannot be cured
with currently available forms of treatment. The major prognostic factor at
the time of diagnosis of upper tract transitional cell cancer is the depth of
infiltration into or through the uroepithelial wall. However, even if
ureteroscopy and pyeloscopy are successfully implemented, accurate assessment
of depth of invasion is difficult. Therefore, total excision of the ureter
with a bladder cuff, renal pelvis, and kidney is recommended in an attempt to
provide the greatest likelihood of cure.
Most superficial tumors are likely to be well differentiated, while infiltrative tumors
are likely to be poorly differentiated. The incidence of
synchronous or metachronous contralateral upper tract cancers ranges from 2% to
4%; the incidence of subsequent bladder cancer after prior upper tract
transitional cell cancer ranges from 30% to 50%.[1] When involvement of the
upper tract is diffuse (involving both the renal pelvis and ureter), the
likelihood of subsequent development of bladder cancer increases to 75%. DNA
ploidy has not added significant prognostic information beyond that provided by
stage and grade.[2]
References
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Krogh J, Kvist E, Rye B: Transitional cell carcinoma of the upper urinary tract: prognostic variables and post-operative recurrences. Br J Urol 67 (1): 32-6, 1991.
[PUBMED Abstract]
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Corrado F, Ferri C, Mannini D, et al.: Transitional cell carcinoma of the upper urinary tract: evaluation of prognostic factors by histopathology and flow cytometric analysis. J Urol 145 (6): 1159-63, 1991.
[PUBMED Abstract]
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