Staging and grading of upper urinary tract urothelial cancer (UTUC)
What is staging and grading?
After a diagnosis of upper urinary tract urothelial cancer, you may have further tests to get more information about the cancer. Your cancer doctor needs this information to advise you on the best treatment for you. It usually includes the following:
- the stage of the cancer – this describes its size and whether it has spread
- the grade of the cancer – this gives an idea of how quickly the cancer might grow and spread.
Your cancer doctor and specialist nurse will talk to you about this.
UTUC staging
Staging for upper urinary tract urothelial cancer refers to:
- how far the cancer has grown into the tissues of the ureter or renal pelvis
- whether it has spread to lymph nodes or other parts of the body.
Stages may be described as a number from 0 to 4.
TNM UTUC staging
T stands for tumour
This explains how far the tumour has grown into the lining of the urinary tract, and how far it has spread into the surrounding tissue.
- T0 – This stage is also called carcinoma in situ. The cancer is only growing on the inside of the lining (mucosa) of the renal pelvis or ureter. It is not growing through it.
- T1 – The cancer has spread through the inner lining (mucosa) of the renal pelvis or ureter, into the connective tissue.
- T2 – The cancer has grown into the muscle layer of the renal pelvis or ureter.
- T3 renal pelvis – The cancer has grown through the muscle to the tissue or fat inside the kidney.
- T3 ureter – The cancer has grown through the muscle into the fat that surrounds the ureter.
- T4 – The cancer has spread into the layer of fat surrounding the kidney or to nearby organs.
N stands for nodes
This explains whether the tumour has spread to lymph nodes.
- N0 means there is no cancer in the lymph nodes.
- N1 means the cancer is in 1 lymph node that measures 2cm or smaller.
- N2 means the cancer is in 1 lymph node that measures more than 2cm, or is in more lymph nodes.
M stands for metastasis
This is whether the tumour has spread to another part of the body. This is called secondary or metastatic cancer.
- M0 means the cancer has not spread to other parts of the body.
- M1 means the cancer has spread to other parts of the body, such as the bones, lungs or liver.
Other terms used for cancer stages
Localised
Regional
Metastatic (secondary)
Related pages
Grading of upper urinary tract urothelial cancer
Grading is how the cancer cells look under a microscope compared with normal cells.
- Low grade means the cancer cells are more like normal cells. The cancer cells are slow growing and less likely to spread.
- High grade means the cancer cells are less like normal cells. The cancer cells grow more quickly and are more likely to spread.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our UTUC information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Rouprêt M, Gontero P, Birtle A et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma. 2023. Available from https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma
Reviewer
Consultant Medical Oncologist & Honorary Associate Professor
University College Hospitals, London
Date reviewed
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