Bladder, ureter & renal pelvis
Staging-renal pelvic carcinoma

Topic Completed: 3 January 2019

Minor changes: 5 May 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Staging [title] renal pelvic tumors kidney

Debra L. Zynger, M.D.
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Page views in 2021 to date: 832
Cite this page: Zynger D. Staging-renal pelvic carcinoma. website. Accessed May 8th, 2021.

Pathologic TNM staging of renal pelvic carcinoma, AJCC 8th edition
Definition / general
  • All carcinomas of the renal pelvis 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
  • ICD-10: C65.9 - renal pelvis
Gross images

Contributed by Debra L. Zynger, M.D.
Renal pelvic and peripelvic fat invasion (pT3)

Renal pelvic and peripelvic fat invasion (pT3)

Primary tumor (pT)
  • pTX: cannot be assessed
  • pT0: no evidence of primary tumor
  • pTa: noninvasive papillary carcinoma
  • pTis: carcinoma in situ
  • pT1: invades subepithelial connective tissue
  • pT2: invades muscle
  • pT3: invades peripelvic fat or renal parenchyma
  • 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 ≤ 2 cm
  • pN2: 1 lymph node with tumor deposit > 2 cm or metastases in multiple nodes

  • Regional lymph nodes include hilar, paracaval, aortic and retroperitoneal
Distant metastasis (pM)
  • pM1: distant metastasis
  • 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 style question #1

A urothelial carcinoma of the renal pelvis at the deepest point of invasion involves the renal parenchyma. Which is the correct pT category?

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