After transitional cell cancer of the renal pelvis and ureter has been diagnosed, tests are done to find out if cancer cells have spread within the renal pelvis and ureter or to other parts of the body.

The process used to find out if cancer has spread within the renal pelvis and ureter or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• Ureteroscopy : A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. The ureteroscope is inserted through the urethra into the bladder, ureter, and renal pelvis. A tool may be inserted through the ureteroscope to take tissue samples to be checked under a microscope for signs of disease.
  Enlarge
  

  Ureteroscopy. A ureteroscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the ureter. The doctor looks at an image of the inside of the ureter on a computer monitor.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for transitional cell cancer of the renal pelvis and/or ureter:

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

In stage 0, abnormal cells are found in tissue lining the inside of the renal pelvis or ureter. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of tumor:

• Stage 0a may look like tiny mushrooms growing from the tissue lining the inside of the renal pelvis or ureter. Stage 0a is also called noninvasive papillary carcinoma.
• Stage 0is is a flat tumor on the tissue lining the inside of the renal pelvis or ureter. Stage 0is is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and spread through the lining of the renal pelvis and/or ureter, into the layer of connective tissue.

Stage II

In stage II, cancer has spread through the layer of connective tissue to the muscle layer of the renal pelvis and/or ureter.

Stage III

In stage III, cancer has spread:

• From the renal pelvis to tissue or fat in the kidney; or
• From the ureter to fat that surrounds the ureter.

Stage IV

In stage IV, cancer has spread to at least one of the following:

• A nearby organ.
• The layer of fat surrounding the kidney.
• One or more lymph nodes.
• Distant parts of the body, such as the lung, liver, or bone.

Transitional cell cancer of the renal pelvis and ureter is also described as localized, regional, or metastatic:

Localized

The cancer is found only in the kidney.

Regional

The cancer has spread to tissues around the kidney and to nearby lymph nodes and blood vessels in the pelvis.

Metastatic

The cancer has spread to other parts of the body.