Bladder and ureters
Miscellaneous
Pathologic TNM staging of ureter carcinoma, AJCC 8th edition


Topic Completed: 3 January 2019

Revised: 2 May 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Ureters malignant tumors staging [title]
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Cite this page: Zynger D. Pathologic TNM staging of ureter carcinoma, AJCC 8th edition. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderstagingureters.html. Accessed June 16th, 2019.
Definition / general
  • All carcinomas of the ureter are covered by this staging system
Essential features
  • AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
ICD coding
Primary tumor (pT)
  • pTX: cannot be assessed
  • pT0: no evidence of primary tumor
  • pTa: noninvasive papillary carcinoma
  • pTis: carcinoma in situ
  • pT1: invades lamina propria
  • pT2: invades muscularis propria
  • pT3: invades periureteric fat
  • pT4: invades adjacent organs or perinephric fat
Regional lymph nodes (pN)
  • pNX: cannot be assessed
  • pN0: no regional lymph node metastasis
  • pN1: 1 lymph node with tumor deposit ≤ cm
  • pN2: 1 lymph node with tumor deposit > 2 cm or metastases in multiple nodes

Notes:
  • Regional lymph nodes include hilar, periureteral, paracaval, iliac (common, internal / hypogastric, external), pelvic
Distant metastasis (pM)
  • pM1: distant metastasis
Prefixes
  • y: preoperative radiotherapy or chemotherapy
  • r: recurrent tumor stage
AJCC prognostic stage groups
Stage group 0a:TaN0M0
Stage group 0is:TisN0M0
Stage group I:T1N0M0
Stage group II:T2N0M0
Stage group III:T3N0M0
Stage group IV:T4NX - 2M0 - 1
TX - 4N1 - 2M0 - 1
TX - 4NX - 2M1
Registry data collection variables
  • Extranodal extension
  • Size of largest tumor deposit within a lymph node
  • Total number of lymph nodes
  • Presence of carcinoma in situ
  • Presence of noninvasive papillary carcinoma
  • Lymphovascular invasion
  • Urothelial carcinoma grade (high / low)
  • Squamous cell / adenocarcinoma grade (1 - 3)
  • Intratubular renal in situ spread
Histologic grade (G)
  • Urothelial carcinoma
    • LG: low grade
    • HG: high grade
  • Squamous cell / adenocarcinoma
    • GX: cannot be assessed
    • G1: well differentiated
    • G2: moderately differentiated
    • G3: poorly differentiated
Histopathologic type
  • Noninvasive urothelial carcinoma
    • Low grade papillary urothelial carcinoma
    • High grade papillary urothelial carcinoma
    • Urothelial carcinoma in situ
  • Invasive urothelial carcinoma
    • Conventional urothelial carcinoma
    • Urothelial carcinoma variants
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Small cell carcinoma
Board review question #1
A urothelial carcinoma of the ureter at the deepest point of invasion involves the muscularis propria. Which is the correct pT category?

  1. pT1
  2. pT2
  3. pT3
  4. pT4
Board review answer #1
B. pT2

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