Bladder, ureter & renal pelvis


Staging-renal pelvic carcinoma

Editorial Board Member: Bonnie Choy, M.D.
Deputy Editor-in-Chief: Maria Tretiakova, M.D., Ph.D.
Debra L. Zynger, M.D.

Last author update: 9 September 2021
Last staff update: 1 December 2022

Copyright: 2003-2023,, Inc.

PubMed Search: Staging [title] renal pelvic tumors kidney

Debra L. Zynger, M.D.
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Cite this page: Zynger DL. Staging-renal pelvic carcinoma. website. Accessed June 8th, 2023.
Definition / general
  • All carcinomas of the renal pelvis are covered by this staging system
  • These tumors are not covered: renal cell carcinoma, lymphoma and mesenchymal tumors
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
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

  • pM is not included in the surgical pathology report unless there is pathologic evidence of distant metastasis (pM1)
  • pMX is no longer utilized
  • 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
Gross images

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

Renal pelvic and peripelvic fat invasion (pT3)

Microscopic (histologic) images

Contributed by Debra L. Zynger, M.D.
Renal parenchyma invasion (pT3) Renal parenchyma invasion (pT3)

Renal parenchyma invasion (pT3)

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
C. pT3. Renal parenchyma invasion is categorized as pT3.

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Reference: Staging-renal pelvic carcinoma
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