672 lines
No EOL
96 KiB
HTML
672 lines
No EOL
96 KiB
HTML
<?xml version="1.0" encoding="utf-8"?>
|
|
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
|
|
|
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
|
<!-- AppResources meta begin -->
|
|
<meta name="paf-app-resources" content="" />
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- AppResources meta end -->
|
|
|
|
<!-- TemplateResources meta begin -->
|
|
<meta name="paf_template" content="" />
|
|
|
|
<!-- TemplateResources meta end -->
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK66010" /><meta name="ncbi_domain" content="pdqcis" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK66010.2/" /><meta name="ncbi_pagename" content="Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="chapter" /><meta name="ncbi_app" content="bookshelf" />
|
|
<!-- Logger end -->
|
|
|
|
<title>Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf</title>
|
|
|
|
<!-- AppResources external_resources begin -->
|
|
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
|
|
|
<!-- AppResources external_resources end -->
|
|
|
|
<!-- Page meta begin -->
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]" /><meta name="citation_title" content="Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)" /><meta name="citation_publisher" content="National Cancer Institute (US)" /><meta name="citation_date" content="2015/10/01" /><meta name="citation_author" content="PDQ Adult Treatment Editorial Board" /><meta name="citation_pmid" content="26389446" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK66010/" /><meta name="citation_keywords" content="transitional cell cancer of the renal pelvis and ureter" /><meta name="citation_keywords" content="transitional cell cancer of the renal pelvis and ureter" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Cancer Institute (US)" /><meta name="DC.Contributor" content="PDQ Adult Treatment Editorial Board" /><meta name="DC.Date" content="2015/10/01" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK66010/" /><meta name="description" content="Expert-reviewed information summary about the treatment of renal pelvis and ureter transitional cell cancer." /><meta name="og:title" content="Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)" /><meta name="og:type" content="book" /><meta name="og:description" content="Expert-reviewed information summary about the treatment of renal pelvis and ureter transitional cell cancer." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK66010/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000062937/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK66010/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
|
|
|
|
<!-- Page meta end -->
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8B37627C931B81000000000025001E.m_13" />
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/4008682/4207974/4206132/4062871/12930/3964959/3854974/36029/4128070/9685/3549676/3609192/3609193/3609213/3395586.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
|
<body class="book-part">
|
|
<div class="grid">
|
|
<div class="col twelve_col nomargin shadow">
|
|
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
|
<div class="sysmessages">
|
|
<noscript>
|
|
<p class="nojs">
|
|
<strong>Warning:</strong>
|
|
The NCBI web site requires JavaScript to function.
|
|
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
|
</p>
|
|
</noscript>
|
|
</div>
|
|
<!--/.sysmessage-->
|
|
<div class="wrap">
|
|
<div class="page">
|
|
<div class="top">
|
|
<div id="universal_header">
|
|
<section class="usa-banner">
|
|
<div class="usa-accordion">
|
|
<header class="usa-banner-header">
|
|
<div class="usa-grid usa-banner-inner">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png" alt="U.S. flag" />
|
|
<p>An official website of the United States government</p>
|
|
<button class="non-usa-accordion-button usa-banner-button" aria-expanded="false" aria-controls="gov-banner-top" type="button">
|
|
<span class="usa-banner-button-text">Here's how you know</span>
|
|
</button>
|
|
</div>
|
|
</header>
|
|
<div class="usa-banner-content usa-grid usa-accordion-content" id="gov-banner-top" aria-hidden="true">
|
|
<div class="usa-banner-guidance-gov usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg" alt="Dot gov" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The .gov means it's official.</strong>
|
|
<br />
|
|
Federal government websites often end in .gov or .mil. Before
|
|
sharing sensitive information, make sure you're on a federal
|
|
government site.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
<div class="usa-banner-guidance-ssl usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg" alt="Https" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The site is secure.</strong>
|
|
<br />
|
|
The <strong>https://</strong> ensures that you are connecting to the
|
|
official website and that any information you provide is encrypted
|
|
and transmitted securely.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<div class="usa-overlay"></div>
|
|
<header class="ncbi-header" role="banner" data-section="Header">
|
|
|
|
<div class="usa-grid">
|
|
<div class="usa-width-one-whole">
|
|
|
|
<div class="ncbi-header__logo">
|
|
<a href="/" class="logo" aria-label="NCBI Logo" data-ga-action="click_image" data-ga-label="NIH NLM Logo">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg" alt="NIH NLM Logo" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ncbi-header__account">
|
|
<a id="account_login" href="https://account.ncbi.nlm.nih.gov" class="usa-button header-button" style="display:none" data-ga-action="open_menu" data-ga-label="account_menu">Log in</a>
|
|
<button id="account_info" class="header-button" style="display:none" aria-controls="account_popup" type="button">
|
|
<span class="fa fa-user" aria-hidden="true">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" width="20px" height="20px">
|
|
<g style="fill: #fff">
|
|
<ellipse cx="12" cy="8" rx="5" ry="6"></ellipse>
|
|
<path d="M21.8,19.1c-0.9-1.8-2.6-3.3-4.8-4.2c-0.6-0.2-1.3-0.2-1.8,0.1c-1,0.6-2,0.9-3.2,0.9s-2.2-0.3-3.2-0.9 C8.3,14.8,7.6,14.7,7,15c-2.2,0.9-3.9,2.4-4.8,4.2C1.5,20.5,2.6,22,4.1,22h15.8C21.4,22,22.5,20.5,21.8,19.1z"></path>
|
|
</g>
|
|
</svg>
|
|
</span>
|
|
<span class="username desktop-only" aria-hidden="true" id="uname_short"></span>
|
|
<span class="sr-only">Show account info</span>
|
|
</button>
|
|
</div>
|
|
|
|
<div class="ncbi-popup-anchor">
|
|
<div class="ncbi-popup account-popup" id="account_popup" aria-hidden="true">
|
|
<div class="ncbi-popup-head">
|
|
<button class="ncbi-close-button" data-ga-action="close_menu" data-ga-label="account_menu" type="button">
|
|
<span class="fa fa-times">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 48 48" width="24px" height="24px">
|
|
<path d="M38 12.83l-2.83-2.83-11.17 11.17-11.17-11.17-2.83 2.83 11.17 11.17-11.17 11.17 2.83 2.83 11.17-11.17 11.17 11.17 2.83-2.83-11.17-11.17z"></path>
|
|
</svg>
|
|
</span>
|
|
<span class="usa-sr-only">Close</span></button>
|
|
<h4>Account</h4>
|
|
</div>
|
|
<div class="account-user-info">
|
|
Logged in as:<br />
|
|
<b><span class="username" id="uname_long">username</span></b>
|
|
</div>
|
|
<div class="account-links">
|
|
<ul class="usa-unstyled-list">
|
|
<li><a id="account_myncbi" href="/myncbi/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_myncbi">Dashboard</a></li>
|
|
<li><a id="account_pubs" href="/myncbi/collections/bibliography/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_pubs">Publications</a></li>
|
|
<li><a id="account_settings" href="/account/settings/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_settings">Account settings</a></li>
|
|
<li><a id="account_logout" href="/account/signout/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_logout">Log out</a></li>
|
|
</ul>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</header>
|
|
<div role="navigation" aria-label="access keys">
|
|
<a id="nws_header_accesskey_0" href="https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys" class="usa-sr-only" accesskey="0" tabindex="-1">Access keys</a>
|
|
<a id="nws_header_accesskey_1" href="https://www.ncbi.nlm.nih.gov" class="usa-sr-only" accesskey="1" tabindex="-1">NCBI Homepage</a>
|
|
<a id="nws_header_accesskey_2" href="/myncbi/" class="set-base-url usa-sr-only" accesskey="2" tabindex="-1">MyNCBI Homepage</a>
|
|
<a id="nws_header_accesskey_3" href="#maincontent" class="usa-sr-only" accesskey="3" tabindex="-1">Main Content</a>
|
|
<a id="nws_header_accesskey_4" href="#" class="usa-sr-only" accesskey="4" tabindex="-1">Main Navigation</a>
|
|
</div>
|
|
<section data-section="Alerts">
|
|
<div class="ncbi-alerts-placeholder"></div>
|
|
</section>
|
|
</div>
|
|
<div class="header">
|
|
<div class="res_logo"><h1 class="res_name"><a href="/books/" title="Bookshelf home">Bookshelf</a></h1><h2 class="res_tagline"></h2></div>
|
|
<div class="search"><form method="get" action="/books/"><div class="search_form"><label for="database" class="offscreen_noflow">Search database</label><select id="database"><optgroup label="Recent"><option value="books" selected="selected" data-ac_dict="bookshelf-search">Books</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="clinvar" class="last">ClinVar</option></optgroup><optgroup label="All"><option value="gquery">All Databases</option><option value="assembly">Assembly</option><option value="biocollections">Biocollections</option><option value="bioproject">BioProject</option><option value="biosample">BioSample</option><option value="books" data-ac_dict="bookshelf-search">Books</option><option value="clinvar">ClinVar</option><option value="cdd">Conserved Domains</option><option value="gap">dbGaP</option><option value="dbvar">dbVar</option><option value="gene">Gene</option><option value="genome">Genome</option><option value="gds">GEO DataSets</option><option value="geoprofiles">GEO Profiles</option><option value="gtr">GTR</option><option value="ipg">Identical Protein Groups</option><option value="medgen">MedGen</option><option value="mesh">MeSH</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore">Nucleotide</option><option value="omim">OMIM</option><option value="pmc">PMC</option><option value="protein">Protein</option><option value="proteinclusters">Protein Clusters</option><option value="protfam">Protein Family Models</option><option value="pcassay">PubChem BioAssay</option><option value="pccompound">PubChem Compound</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="snp">SNP</option><option value="sra">SRA</option><option value="structure">Structure</option><option value="taxonomy">Taxonomy</option><option value="toolkit">ToolKit</option><option value="toolkitall">ToolKitAll</option><option value="toolkitbookgh">ToolKitBookgh</option></optgroup></select><div class="nowrap"><label for="term" class="offscreen_noflow" accesskey="/">Search term</label><div class="nowrap"><input type="text" name="term" id="term" title="Search Books. Use up and down arrows to choose an item from the autocomplete." value="" class="jig-ncbiclearbutton jig-ncbiautocomplete" data-jigconfig="dictionary:'bookshelf-search',disableUrl:'NcbiSearchBarAutoComplCtrl'" autocomplete="off" data-sbconfig="ds:'no',pjs:'no',afs:'no'" /></div><button id="search" type="submit" class="button_search nowrap" cmd="go">Search</button></div></div></form><ul class="searchlinks inline_list"><li>
|
|
<a href="/books/browse/">Browse Titles</a>
|
|
</li><li>
|
|
<a href="/books/advanced/">Advanced</a>
|
|
</li><li class="help">
|
|
<a href="/books/NBK3833/">Help</a>
|
|
</li><li class="disclaimer">
|
|
<a target="_blank" data-ga-category="literature_resources" data-ga-action="link_click" data-ga-label="disclaimer_link" href="https://www.ncbi.nlm.nih.gov/books/about/disclaimer/">Disclaimer</a>
|
|
</li></ul></div>
|
|
</div>
|
|
|
|
|
|
|
|
<!--<component id="Page" label="headcontent"/>-->
|
|
|
|
</div>
|
|
<div class="content">
|
|
<!-- site messages -->
|
|
<!-- Custom content 1 -->
|
|
<div class="col1">
|
|
|
|
</div>
|
|
|
|
<div class="container">
|
|
<div id="maincontent" class="content eight_col col">
|
|
<!-- Custom content in the left column above book nav -->
|
|
<div class="col2">
|
|
|
|
</div>
|
|
|
|
<!-- Book content -->
|
|
|
|
|
|
<!-- Custom content between navigation and content -->
|
|
<div class="col3">
|
|
|
|
</div>
|
|
|
|
<div class="document">
|
|
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK66010_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK66010_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
|
|
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK66010_"><span class="title" itemprop="name">Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: October 1, 2015.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062937__135">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of transitional cell cancer of the renal pelvis and ureter. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062937__136">This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062937__1"><h2 id="_CDR0000062937__1_">General Information About Transitional Cell Cancer of the Renal Pelvis and Ureter </h2><div id="CDR0000062937__126"><h3>Incidence and Mortality</h3><p id="CDR0000062937__2">Transitional cell carcinoma of the renal pelvis, accounting for only 7% of all
|
|
kidney tumors, and transitional cell cancer of the ureter, accounting for only
|
|
1 of every 25 upper tract tumors, are curable in more than 90% of patients if
|
|
they are superficial and confined to the renal pelvis or ureter. Patients with
|
|
deeply invasive tumors that are still confined to the renal pelvis or ureter
|
|
have a 10% to 15% likelihood of cure. Patients with tumors with penetration
|
|
through the urothelial wall or with distant metastases usually cannot be cured
|
|
with currently available forms of treatment. </p></div><div id="CDR0000062937__127"><h3>Prognosis</h3><p id="CDR0000062937__128">The major prognostic factor at
|
|
the time of diagnosis of upper tract transitional cell cancer is the depth of
|
|
infiltration into or through the uroepithelial wall. </p><p id="CDR0000062937__3">Most superficial tumors are likely to be well differentiated, while infiltrative tumors
|
|
are likely to be poorly differentiated. The incidence of
|
|
synchronous or metachronous contralateral upper tract cancers ranges from 2% to
|
|
4%; the incidence of subsequent bladder cancer after prior upper tract
|
|
transitional cell cancer ranges from 30% to 50%.[<a class="bk_pop" href="#CDR0000062937_rl_1_1">1</a>] When involvement of the
|
|
upper tract is diffuse (involving both the renal pelvis and ureter), the
|
|
likelihood of subsequent development of bladder cancer increases to 75%. DNA
|
|
ploidy has not added significant prognostic information beyond that provided by
|
|
stage and grade.[<a class="bk_pop" href="#CDR0000062937_rl_1_2">2</a>]
|
|
</p></div><div id="CDR0000062937__129"><h3>Diagnostics</h3><p id="CDR0000062937__130">Even if
|
|
ureteroscopy and pyeloscopy are successfully implemented, accurate assessment
|
|
of depth of invasion is difficult.</p></div><div id="CDR0000062937__131"><h3>Treatment Management and Survivorship</h3><p id="CDR0000062937__132">Total excision of the ureter
|
|
with a bladder cuff, renal pelvis, and kidney is recommended in an attempt to
|
|
provide the greatest likelihood of cure.
|
|
</p></div><div id="CDR0000062937_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062937_rl_1_1">Krogh J, Kvist E, Rye B: Transitional cell carcinoma of the upper urinary tract: prognostic variables and post-operative recurrences. Br J Urol 67 (1): 32-6, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1993274" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1993274</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_1_2">Corrado F, Ferri C, Mannini D, et al.: Transitional cell carcinoma of the upper urinary tract: evaluation of prognostic factors by histopathology and flow cytometric analysis. J Urol 145 (6): 1159-63, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/2033684" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2033684</span></a>]</div></li></ol></div></div><div id="CDR0000062937__4"><h2 id="_CDR0000062937__4_">Cellular Classification of Transitional Cell Cancer of the Renal Pelvis and Ureter </h2><p id="CDR0000062937__5">The majority of upper tract uroepithelial tumors are of transitional cell
|
|
histology. Squamous cell cancer of the urinary tract constitutes less than 15%
|
|
of the tumors of the renal pelvis and a smaller percentage of ureteral tumors
|
|
and is often associated with chronic calculus disease and infection.
|
|
</p><p id="CDR0000062937__6">Grade of transitional cell cancer of the upper tract has generally been found
|
|
to correlate with stage. Superficial tumors are generally grade I or II,
|
|
whereas the majority of infiltrative tumors are grades III and IV. Prognosis
|
|
is worse for patients with high-grade (grades III and IV) tumors than for those
|
|
with low-grade (grades I and II) tumors.
|
|
</p></div><div id="CDR0000062937__7"><h2 id="_CDR0000062937__7_">Stage Information for Transitional Cell Cancer of the Renal Pelvis and Ureter</h2><p id="CDR0000062937__8">Though comparable in many respects to staging systems described for bladder
|
|
cancer, unique structural aspects of the renal pelvis and ureter have led to
|
|
several differences in the classification schema of tumors that involve the
|
|
upper tracts. Clinical staging is based on a combination of radiographic
|
|
procedures (e.g., intravenous pyelogram and computed tomographic scans) and,
|
|
more recently, ureteroscopy and biopsy.
|
|
</p><p id="CDR0000062937__9">The advent of rigid and flexible ureteroscopic techniques has permitted
|
|
endoscopic access to the ureter and renal pelvis. This may permit greater
|
|
accuracy in preoperative definition of the stage and grade of an upper tract
|
|
neoplasm. In addition, fulguration and endourological access permit resection
|
|
or laser coagulation of highly selected low-stage, low-grade lesions of the
|
|
ureters.[<a class="bk_pop" href="#CDR0000062937_rl_7_1">1</a>] However, this approach is still under clinical evaluation since
|
|
there is the possibility of inaccurate assessment of the stage and extent of
|
|
disease, and the adequacy and risks of such treatment have not yet been
|
|
defined.[<a class="bk_pop" href="#CDR0000062937_rl_7_2">2</a>-<a class="bk_pop" href="#CDR0000062937_rl_7_5">5</a>]
|
|
</p><p id="CDR0000062937__10">Because of the inaccessibility of ureteral and pelvic anatomy, accurate staging
|
|
requires pathologic analysis of the surgically excised specimen.
|
|
</p><div id="CDR0000062937__115"><h3>Definitions of TNM</h3><p id="CDR0000062937__114">The American Joint Committee on Cancer (AJCC) has designated staging by TNM
|
|
classification to define carcinoma of the renal pelvis and ureter.[<a class="bk_pop" href="#CDR0000062937_rl_7_6">6</a>]</p><div id="CDR0000062937__109" class="table"><h3><span class="title">Table 1. Primary Tumor (T)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK66010.2/table/CDR0000062937__109/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062937__109_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">TX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Primary tumor cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No evidence of primary tumor.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Ta</td><td colspan="1" rowspan="1" style="vertical-align:top;">Papillary noninvasive carcinoma.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tis</td><td colspan="1" rowspan="1" style="vertical-align:top;">Carcinoma <i>in situ</i>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades subepithelial connective tissue.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades the muscularis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">(For renal pelvis only) Tumor invades beyond muscularis into peripelvic fat or the renal parenchyma T3. (For ureter only) Tumor invades beyond muscularis into periureteric fat.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades adjacent organs, or through the kidney into the perinephric fat.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 491-6.</p></div></dd></dl></div></div></div><div id="CDR0000062937__110" class="table"><h3><span class="title">Table 2. Regional Lymph Nodes (N)<sup>a,</sup><sup>b</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK66010.2/table/CDR0000062937__110/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062937__110_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">NX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Regional lymph nodes cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a single lymph node, ≤2 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a single lymph node, >2 cm but not >5 cm in greatest dimension; or multiple lymph nodes, none >5 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a lymph node, >5 cm in greatest dimension.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 491-6.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Laterality does not affect the N classification.</p></div></dd></dl></div></div></div><div id="CDR0000062937__111" class="table"><h3><span class="title">Table 3. Distant Metastasis (M)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK66010.2/table/CDR0000062937__111/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062937__111_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 491-6.</p></div></dd></dl></div></div></div><div id="CDR0000062937__112" class="table"><h3><span class="title">Table 4. Anatomic Stage/ Prognostic Groups<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK66010.2/table/CDR0000062937__112/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062937__112_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">T</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">N</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">M</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">0a</td><td colspan="1" rowspan="1" style="vertical-align:top;">Ta</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">0is</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> I</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> II</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> III</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">IV</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any N</td><td colspan="1" rowspan="1" style="vertical-align:top;">M1</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 491-6.</p></div></dd></dl></div></div></div><p id="CDR0000062937__36"><div class="milestone-start" id="CDR0000062937__23"></div>Patients may also be designated as having localized, regional, or metastatic
|
|
disease, as follows:
|
|
</p><p id="CDR0000062937__90"><b><div class="milestone-start" id="CDR0000062937__37"></div>Localized</b></p><p id="CDR0000062937__38">Patients with localized disease may be classified into three groups:
|
|
</p><ul id="CDR0000062937__75"><li class="half_rhythm"><div>Group 1: Low-grade tumor confined to the urothelium without lamina propria
|
|
invasion (“Papilloma” Grade I transitional cell cancer).
|
|
</div></li><li class="half_rhythm"><div>Group 2: Grade I–III carcinomas without demonstrable subepithelial invasion or
|
|
focal microscopic invasion or papillary carcinomas with carcinoma in situ and/or carcinoma in situ elsewhere in the urothelium.
|
|
</div></li><li class="half_rhythm"><div>Group 3: High-grade tumors that have infiltrated the renal pelvic wall or renal
|
|
parenchyma or both but are still confined to the kidney. Infiltration of
|
|
muscle in the upper tract may not be associated with as much potential for
|
|
distant dissemination as appears to be the case for bladder cancer.
|
|
<div class="milestone-end"></div></div></li></ul><p id="CDR0000062937__91"><b><div class="milestone-start" id="CDR0000062937__42"></div>Regional</b></p><ul id="CDR0000062937__76"><li class="half_rhythm"><div>Group 4: Extension of tumors beyond the renal pelvis or parenchyma and invasion
|
|
of peripelvic and perirenal fat, lymph nodes, hilar vessels, and adjacent
|
|
tissues.
|
|
<div class="milestone-end"></div></div></li></ul><p id="CDR0000062937__92"><b><div class="milestone-start" id="CDR0000062937__44"></div>Metastatic</b></p><ul id="CDR0000062937__77"><li class="half_rhythm"><div>Spread of the tumor to distant tissues.
|
|
<div class="milestone-end"></div></div></li></ul><p id="CDR0000062937__46">Each of these classifications has been subclassified into categories of
|
|
unicentricity or multicentricity. The latter category indicates a more pervasive tumor
|
|
diathesis and generally a less favorable prognosis.
|
|
</p><p id="CDR0000062937__47">Although the classifications listed above have prognostic significance, they
|
|
can only be determined at the time of nephroureterectomy, which is the
|
|
treatment of choice for patients with this disease. Because of the high
|
|
incidence of tumor recurrence within the intramural ureter among patients who
|
|
have had incomplete excision of this area, nephroureterectomy should include
|
|
the entire ureter and a margin of periureteral orifice mucosa (i.e., bladder cuff).
|
|
</p><p id="CDR0000062937__48">A TNM system for staging has been established and has demonstrated accurate
|
|
predictions of survival. The TNM staging system may be a better predictor of
|
|
prognosis than tumor grade, though both are strongly predictive of survival.
|
|
Median survival for patients with tumors confined to the subepithelial
|
|
connective tissue was 91.1 months compared to 12.9 months for patients with
|
|
tumors invading the muscularis and beyond in one report. Flow cytometry analysis
|
|
identifies low-stage, low-grade tumors at high risk of recurrence by virtue of
|
|
their aneuploid histograms.<div class="milestone-end"></div>[<a class="bk_pop" href="#CDR0000062937_rl_7_7">7</a>,<a class="bk_pop" href="#CDR0000062937_rl_7_8">8</a>]
|
|
</p></div><div id="CDR0000062937_rl_7"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062937_rl_7_1">Grossman HB, Schwartz SL, Konnak JW: Ureteroscopic treatment of urothelial carcinoma of the ureter and renal pelvis. J Urol 148 (2 Pt 1): 275-7, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1635116" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1635116</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_7_2">Batata M, Grabstald H: Upper urinary tract urothelial tumors. Urol Clin North Am 3 (1): 79-86, 1976. [<a href="https://pubmed.ncbi.nlm.nih.gov/936370" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 936370</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_7_3">Cummings KB, Correa RJ Jr, Gibbons RP, et al.: Renal pelvic tumors. J Urol 113 (2): 158-62, 1975. [<a href="https://pubmed.ncbi.nlm.nih.gov/1113408" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1113408</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_7_4">Nocks BN, Heney NM, Daly JJ, et al.: Transitional cell carcinoma of renal pelvis. Urology 19 (5): 472-7, 1982. [<a href="https://pubmed.ncbi.nlm.nih.gov/7080318" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7080318</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_7_5">Heney NM, Nocks BN, Daly JJ, et al.: Prognostic factors in carcinoma of the ureter. J Urol 125 (5): 632-6, 1981. [<a href="https://pubmed.ncbi.nlm.nih.gov/7230332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7230332</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_7_6">Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, p 493.</div></li><li><div class="bk_ref" id="CDR0000062937_rl_7_7">Huben RP, Mounzer AM, Murphy GP: Tumor grade and stage as prognostic variables in upper tract urothelial tumors. Cancer 62 (9): 2016-20, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/3167813" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3167813</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_7_8">Blute ML, Tsushima K, Farrow GM, et al.: Transitional cell carcinoma of the renal pelvis: nuclear deoxyribonucleic acid ploidy studied by flow cytometry. J Urol 140 (5): 944-9, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/3172363" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3172363</span></a>]</div></li></ol></div></div><div id="CDR0000062937__49"><h2 id="_CDR0000062937__49_">Treatment Option Overview</h2><p id="CDR0000062937__50">The rarity of synchronous bilateral renal pelvic neoplasia, the low incidence
|
|
of asynchronous development of contralateral upper tract tumors, and the
|
|
increased risk of tumor recurrence in the ipsilateral ureter distal to the
|
|
original pelvic tumor are the rationale for total nephroureterectomy with
|
|
bladder cuff for most patients with renal pelvic transitional cell cancers and
|
|
ureteral cancers.
|
|
</p><p id="CDR0000062937__51">Contemplation of anything less than total excision must take into account the
|
|
potential risk for tumor recurrence anywhere in the upper tract unit. In other
|
|
than unifocal, low-grade, low-stage renal pelvic tumors, the probable extensive
|
|
involvement of both contiguous and noncontiguous sites would appear to make
|
|
segmental excision an unnecessary option with a potentially serious risk.
|
|
However, an operative possibility includes segmental excision of a particular
|
|
lesion. If the extent of a tumor can be determined by intraoperative
|
|
assessment, and frozen section histologic diagnosis confirms low-grade,
|
|
unifocal tumor of limited size, then segmental excision is possible. However,
|
|
this approach should be reserved for highly selected patients. This includes
|
|
those patients who have a solitary kidney or those with decreased renal
|
|
function and who require maximal preservation of renal tissue. The likelihood
|
|
of tumor recurrence in this setting, and of extension of disease outside the
|
|
renal pelvis once the pelvis has been violated, is a serious risk that must be
|
|
heavily weighed in offering a patient this therapeutic option.
|
|
</p><p id="CDR0000062937__52">Ureteral transitional cell cancer may more readily offer the possibility of
|
|
segmental excision if the absence of proximal disease can be documented. In
|
|
this setting, attention is focused on the ease of reconstruction of the ureter
|
|
and restoration of ureterovesical continuity. This is most feasible if the
|
|
cancer is in the distal ureter. If partial ureterectomy is possible and
|
|
proximal disease has been excluded, then segmental excision and ureteral
|
|
reimplantation can be performed.
|
|
</p><p id="CDR0000062937__53">Systematic regional lymph node dissection in conjunction with
|
|
nephroureterectomy or segmental excision has not been found to enhance the
|
|
effectiveness of surgery if tumors are of high grade or high stage, since in
|
|
these instances the overall results are so poor. Correspondingly, lymph node
|
|
involvement is uncommon in low-stage disease, and lymphadenectomy is therefore
|
|
unlikely to remove additional tumor. Thus, lymph node dissection at the time
|
|
of nephrectomy may offer prognostic information, but little, if any,
|
|
therapeutic benefit.
|
|
</p></div><div id="CDR0000062937__55"><h2 id="_CDR0000062937__55_">Localized Transitional Cell Cancer of the Renal Pelvis and Ureter</h2><p id="CDR0000062937__56"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062937__78"><li class="half_rhythm"><div>Nephroureterectomy with cuff of bladder.</div></li><li class="half_rhythm"><div>Segmental resection of ureter, only if the tumor is superficial and located
|
|
in the distal third of the ureter.</div></li></ol><p id="CDR0000062937__59"><b>Treatment options under clinical evaluation:
|
|
</b></p><p id="CDR0000062937__60">The development of new instrumentation for endourological treatment of upper
|
|
tract transitional cell cancer has provided new options for regional management
|
|
of these cancers. Introduction of electrofulguration and resection instruments
|
|
or laser probes either transureterally or percutaneously may permit destruction
|
|
of a primary cancer. Introduction of cytotoxic agents has also been employed.
|
|
Although a biopsy can be taken for staging purposes, the accuracy of this
|
|
remains to be determined. The efficacy of treatment by these maneuvers has not
|
|
been established.
|
|
</p><ol id="CDR0000062937__79"><li class="half_rhythm"><div>Electroresection and fulguration or laser fulguration, if the tumor is
|
|
superficial.
|
|
</div></li><li class="half_rhythm"><div>Any parenchymal sparing procedure (segmental resection; ureteroscopic or
|
|
percutaneous resection/fulguration/laser destruction) if the renal unit is
|
|
solitary or renal function is depressed.</div></li><li class="half_rhythm"><div>Intrapelvic or intraureteral cytotoxic/immunotherapy. The dramatic
|
|
successes that have been reported with intravesical cytotoxic (thiotepa,
|
|
mitomycin, doxorubicin) or immunologic/inflammatory (BCG, interferon) therapy
|
|
for superficial transitional cell cancers in the bladder have led to the
|
|
occasional use of these agents in the treatment of upper tract cancers.
|
|
Long-term follow-up of the results of such treatments has generally not been
|
|
reported, and the efficacy of this approach cannot be assessed, largely because
|
|
experience has been limited to those patients whose compromised clinical status
|
|
(solitary kidney, renal failure, medical risks for surgery) may have influenced
|
|
clinical outcome. The use of this approach will be limited by the extent of
|
|
disease in the renal pelvis, the access that these agents may have to the area
|
|
of disease, the sensitivity of the cancer being treated, and the adequacy and
|
|
accuracy of initial tumor staging and continued monitoring.
|
|
</div></li><li class="half_rhythm"><div>Laser vaporization/coagulation. Transurethral and percutaneous access to
|
|
the upper tract have permitted the use of laser therapy in the control of
|
|
superficial upper tract transitional cell cancers. This approach is dependent
|
|
on accurate staging and adequate visualization of the lesions that need to be
|
|
coagulated. Results of this approach are at present too preliminary to assess.
|
|
Therapeutic efficacy, however, will depend on staging accuracy on initial
|
|
treatment and ease of monitoring such patients for disease recurrence and
|
|
possible progression.
|
|
</div></li></ol><div id="CDR0000062937__TrialSearch_55_sid_5"><h3>Current Clinical Trials</h3><p id="CDR0000062937__TrialSearch_55_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000062937__65"><h2 id="_CDR0000062937__65_">Regional Transitional Cell Cancer of the Renal Pelvis and Ureter</h2><p id="CDR0000062937__66">Treatment of extensive regional disease has thus far not had well-documented
|
|
success by either radiation or systemic chemotherapy. Patients with extensive
|
|
regional disease should be considered for clinical trials.
|
|
</p><div id="CDR0000062937__TrialSearch_65_sid_6"><h3>Current Clinical Trials</h3><p id="CDR0000062937__TrialSearch_65_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000062937__67"><h2 id="_CDR0000062937__67_">Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter</h2><p id="CDR0000062937__68">The prognosis for any patient with metastatic or recurrent transitional cell
|
|
cancer is poor. The proper management of recurrence depends on the sites of
|
|
recurrence, extent of prior therapy, and individual patient considerations.
|
|
Chemotherapy regimens that have been shown effective for metastatic bladder
|
|
cancer have generally been applied to transitional cell cancers arising from
|
|
other sites. Patients with distant metastases have a poor prognosis and can
|
|
be appropriately offered treatment on a clinical trial.
|
|
</p><p id="CDR0000062937__69">In patients with metastatic or recurrent transitional cell carcinoma of the
|
|
bladder, combination chemotherapy has produced high response rates and
|
|
occasional complete responses.[<a class="bk_pop" href="#CDR0000062937_rl_67_1">1</a>,<a class="bk_pop" href="#CDR0000062937_rl_67_2">2</a>] Results from a randomized trial that
|
|
compared methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) to
|
|
single-agent cisplatin in advanced bladder cancer show a significant advantage
|
|
with M-VAC in both response rate and median survival. The overall response
|
|
rate with M-VAC in this cooperative group trial was 39%.[<a class="bk_pop" href="#CDR0000062937_rl_67_3">3</a>]
|
|
</p><p id="CDR0000062937__84">Other chemotherapy agents that have shown activity in metastatic transitional
|
|
cell cancer include the following:[<a class="bk_pop" href="#CDR0000062937_rl_67_4">4</a>-<a class="bk_pop" href="#CDR0000062937_rl_67_8">8</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000587991/" class="def">Level of evidence: 3iiiDiv</a>]</p><ul id="CDR0000062937__80"><li class="half_rhythm"><div>Paclitaxel.</div></li><li class="half_rhythm"><div>Ifosfamide.</div></li><li class="half_rhythm"><div>Gallium nitrate.</div></li><li class="half_rhythm"><div>Gemcitabine.</div></li><li class="half_rhythm"><div>Pemetrexed.</div></li></ul><p id="CDR0000062937__81">Ifosfamide, gallium, and pemetrexed have shown limited activity in
|
|
patients previously treated with cisplatin. </p><div id="CDR0000062937__TrialSearch_67_sid_7"><h3>Current Clinical Trials</h3><p id="CDR0000062937__TrialSearch_67_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062937_rl_67"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062937_rl_67_1">Sternberg CN, Yagoda A, Scher HI, et al.: Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. Cancer 64 (12): 2448-58, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2819654" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2819654</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_67_2">Harker WG, Meyers FJ, Freiha FS, et al.: Cisplatin, methotrexate, and vinblastine (CMV): an effective chemotherapy regimen for metastatic transitional cell carcinoma of the urinary tract. A Northern California Oncology Group study. J Clin Oncol 3 (11): 1463-70, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/4056840" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4056840</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_67_3">Loehrer PJ Sr, Einhorn LH, Elson PJ, et al.: A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 10 (7): 1066-73, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1607913" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1607913</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_67_4">Roth BJ: Preliminary experience with paclitaxel in advanced bladder cancer. Semin Oncol 22 (3 Suppl 6): 1-5, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7541150" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7541150</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_67_5">Witte RS, Elson P, Bono B, et al.: Eastern Cooperative Oncology Group phase II trial of ifosfamide in the treatment of previously treated advanced urothelial carcinoma. J Clin Oncol 15 (2): 589-93, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9053481" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9053481</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_67_6">Einhorn LH, Roth BJ, Ansari R, et al.: Phase II trial of vinblastine, ifosfamide, and gallium combination chemotherapy in metastatic urothelial carcinoma. J Clin Oncol 12 (11): 2271-6, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7525884" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7525884</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_67_7">Pollera CF, Ceribelli A, Crecco M, et al.: Weekly gemcitabine in advanced bladder cancer: a preliminary report from a phase I study. Ann Oncol 5 (2): 182-4, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8186164" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8186164</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_67_8">Sweeney CJ, Roth BJ, Kabbinavar FF, et al.: Phase II study of pemetrexed for second-line treatment of transitional cell cancer of the urothelium. J Clin Oncol 24 (21): 3451-7, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16849761" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16849761</span></a>]</div></li></ol></div></div><div id="CDR0000062937__71"><h2 id="_CDR0000062937__71_">Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter</h2><p id="CDR0000062937__72">The prognosis for any patient with metastatic or recurrent transitional cell
|
|
cancer is poor. The proper management of recurrence depends on the sites of
|
|
recurrence, extent of prior therapy, and individual patient considerations.
|
|
Chemotherapy regimens that have been shown effective for metastatic bladder
|
|
cancer have generally been applied to transitional cell cancers arising from
|
|
other sites. Patients with distant metastases have a poor prognosis, and can
|
|
be appropriately offered treatment on a clinical trial.
|
|
</p><p id="CDR0000062937__73">In patients with metastatic or recurrent transitional cell carcinoma of the
|
|
bladder, combination chemotherapy has produced high response rates and
|
|
occasional complete responses.[<a class="bk_pop" href="#CDR0000062937_rl_71_1">1</a>,<a class="bk_pop" href="#CDR0000062937_rl_71_2">2</a>] Results from a randomized trial that
|
|
compared methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) to
|
|
single-agent cisplatin in advanced bladder cancer show a significant advantage
|
|
with M-VAC in both response rate and median survival. The overall response
|
|
rate with M-VAC in this cooperative group trial was 39%.[<a class="bk_pop" href="#CDR0000062937_rl_71_3">3</a>]
|
|
</p><p id="CDR0000062937__85">Other chemotherapy agents that have shown activity in metastatic transitional
|
|
cell cancer include the following:[<a class="bk_pop" href="#CDR0000062937_rl_71_4">4</a>-<a class="bk_pop" href="#CDR0000062937_rl_71_8">8</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000587991/" class="def">Level of evidence: 3iiiDiv</a>]</p><ul id="CDR0000062937__82"><li class="half_rhythm"><div>Paclitaxel.</div></li><li class="half_rhythm"><div>Ifosfamide.</div></li><li class="half_rhythm"><div>Gallium nitrate.</div></li><li class="half_rhythm"><div>Gemcitabine.</div></li><li class="half_rhythm"><div>Pemetrexed.</div></li></ul><p id="CDR0000062937__83">Ifosfamide, gallium, and pemetrexed have shown limited activity in
|
|
patients previously treated with cisplatin.</p><div id="CDR0000062937__TrialSearch_71_sid_8"><h3>Current Clinical Trials</h3><p id="CDR0000062937__TrialSearch_71_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062937_rl_71"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062937_rl_71_1">Sternberg CN, Yagoda A, Scher HI, et al.: Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. Cancer 64 (12): 2448-58, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2819654" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2819654</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_71_2">Harker WG, Meyers FJ, Freiha FS, et al.: Cisplatin, methotrexate, and vinblastine (CMV): an effective chemotherapy regimen for metastatic transitional cell carcinoma of the urinary tract. A Northern California Oncology Group study. J Clin Oncol 3 (11): 1463-70, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/4056840" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4056840</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_71_3">Loehrer PJ Sr, Einhorn LH, Elson PJ, et al.: A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 10 (7): 1066-73, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1607913" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1607913</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_71_4">Roth BJ: Preliminary experience with paclitaxel in advanced bladder cancer. Semin Oncol 22 (3 Suppl 6): 1-5, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7541150" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7541150</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_71_5">Witte RS, Elson P, Bono B, et al.: Eastern Cooperative Oncology Group phase II trial of ifosfamide in the treatment of previously treated advanced urothelial carcinoma. J Clin Oncol 15 (2): 589-93, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9053481" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9053481</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_71_6">Einhorn LH, Roth BJ, Ansari R, et al.: Phase II trial of vinblastine, ifosfamide, and gallium combination chemotherapy in metastatic urothelial carcinoma. J Clin Oncol 12 (11): 2271-6, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7525884" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7525884</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_71_7">Pollera CF, Ceribelli A, Crecco M, et al.: Weekly gemcitabine in advanced bladder cancer: a preliminary report from a phase I study. Ann Oncol 5 (2): 182-4, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8186164" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8186164</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062937_rl_71_8">Sweeney CJ, Roth BJ, Kabbinavar FF, et al.: Phase II study of pemetrexed for second-line treatment of transitional cell cancer of the urothelium. J Clin Oncol 24 (21): 3451-7, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16849761" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16849761</span></a>]</div></li></ol></div></div><div id="CDR0000062937__86"><h2 id="_CDR0000062937__86_">Changes to This Summary (10/01/2015)</h2><p id="CDR0000062937__87">The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.</p><p id="CDR0000062937__137">Editorial changes were made to this summary.</p><p id="CDR0000062937__disclaimerHP_3">This summary is written and maintained by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
|
|
editorially independent of NCI. The summary reflects an independent review of
|
|
the literature and does not represent a policy statement of NCI or NIH. More
|
|
information about summary policies and the role of the PDQ Editorial Boards in
|
|
maintaining the PDQ summaries can be found on the <a href="#CDR0000062937__AboutThis_1">About This PDQ Summary</a> and <a href="http://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
|
|
</p></div><div id="CDR0000062937__AboutThis_1"><h2 id="_CDR0000062937__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062937__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062937__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of transitional cell cancer of the renal pelvis and ureter. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062937__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062937__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062937__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062937__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062937__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p>The lead reviewer for Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment is:</p><ul><li class="half_rhythm"><div>Timothy Gilligan, MD (Cleveland Clinic Taussig Cancer Institute)</div></li></ul><p id="CDR0000062937__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062937__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062937__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062937__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062937__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062937__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062937__AboutThis_15">PDQ® Adult Treatment Editorial Board. PDQ Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/kidney/hp/transitional-cell-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/kidney/hp/transitional-cell-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389446]</p><p id="CDR0000062937__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
|
|
</p></div><div id="CDR0000062937__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062937__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062937__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062937__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
|
|
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK66010</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389446" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389446</a></span></div></div></div>
|
|
|
|
</div>
|
|
|
|
<!-- Custom content below content -->
|
|
<div class="col4">
|
|
|
|
</div>
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<!-- Custom contetnt below bottom nav -->
|
|
<div class="col5">
|
|
|
|
</div>
|
|
</div>
|
|
|
|
<div id="rightcolumn" class="four_col col last">
|
|
<!-- Custom content above discovery portlets -->
|
|
<div class="col6">
|
|
<div id="ncbi_share_book"><a href="#" class="ncbi_share" data-ncbi_share_config="popup:false,shorten:true" ref="id=NBK66010&db=books">Share</a></div>
|
|
|
|
</div>
|
|
<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66010.2/?report=reader">PubReader</a></li><li><a href="/books/NBK66010.2/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK66010" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK66010" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®): Health Professional Version. 2015 Oct 1. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK66010.6/">NBK66010.6</a></span> January 5, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK66010.5/">NBK66010.5</a></span> January 30, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK66010.4/">NBK66010.4</a></span> March 24, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK66010.3/">NBK66010.3</a></span> February 7, 2018</li><li><span class="bk_col_itm">NBK66010.2</span> October 1, 2015 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK66010.1/">NBK66010.1</a></span> February 25, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062937__1" ref="log$=inpage&link_id=inpage">General Information About Transitional Cell Cancer of the Renal Pelvis and Ureter </a></li><li><a href="#CDR0000062937__4" ref="log$=inpage&link_id=inpage">Cellular Classification of Transitional Cell Cancer of the Renal Pelvis and Ureter </a></li><li><a href="#CDR0000062937__7" ref="log$=inpage&link_id=inpage">Stage Information for Transitional Cell Cancer of the Renal Pelvis and Ureter</a></li><li><a href="#CDR0000062937__49" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062937__55" ref="log$=inpage&link_id=inpage">Localized Transitional Cell Cancer of the Renal Pelvis and Ureter</a></li><li><a href="#CDR0000062937__65" ref="log$=inpage&link_id=inpage">Regional Transitional Cell Cancer of the Renal Pelvis and Ureter</a></li><li><a href="#CDR0000062937__67" ref="log$=inpage&link_id=inpage">Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter</a></li><li><a href="#CDR0000062937__71" ref="log$=inpage&link_id=inpage">Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter</a></li><li><a href="#CDR0000062937__86" ref="log$=inpage&link_id=inpage">Changes to This Summary (10/01/2015)</a></li><li><a href="#CDR0000062937__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65846/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pubmed&DbFrom=books&Cmd=Link&LinkName=books_pubmed_refs&IdsFromResult=2825568" ref="log$=recordlinks">PubMed</a><div class="brieflinkpop offscreen_noflow">Links to PubMed</div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/33724749" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hereditary Leiomyomatosis and Renal Cell Cancer (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hereditary Leiomyomatosis and Renal Cell Cancer (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Cancer Genetics Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/33724750" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hereditary Papillary Renal Carcinoma (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hereditary Papillary Renal Carcinoma (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Cancer Genetics Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389173" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Delirium (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Delirium (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389421" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> 714-X (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> 714-X (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389287" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gonzalez Regimen (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gonzalez Regimen (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389446" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=26389446" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c93388b15b832ebc14b200">Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®) - PDQ C...</a><div class="ralinkpop offscreen_noflow">Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_qry two_line"><a class="htb" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c9337ba68b6b5afc77695d">PMC Links for Books (Select 2829060) <span class="number">(2)</span></a><div class="tertiary">PMC</div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c9337af4a390645e3ca789">Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®) - PDQ Cancer In...</a><div class="ralinkpop offscreen_noflow">Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_qry two_line"><a class="htb" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c93365f4a390645e3c1c43">PMC Links for Books (Select 2828216) <span class="number">(9)</span></a><div class="tertiary">PMC</div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c93363b15b832ebc13b759">Spirituality in Cancer Care (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Spirituality in Cancer Care (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
|
|
|
|
<!-- Custom content below discovery portlets -->
|
|
<div class="col7">
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<!-- Custom content after all -->
|
|
<div class="col8">
|
|
|
|
</div>
|
|
<div class="col9">
|
|
|
|
</div>
|
|
|
|
<script type="text/javascript" src="/corehtml/pmc/js/jquery.scrollTo-1.4.2.js"></script>
|
|
<script type="text/javascript">
|
|
(function($){
|
|
$('.skiplink').each(function(i, item){
|
|
var href = $($(item).attr('href'));
|
|
href.attr('tabindex', '-1').addClass('skiptarget'); // ensure the target can receive focus
|
|
$(item).on('click', function(event){
|
|
event.preventDefault();
|
|
$.scrollTo(href, 0, {
|
|
onAfter: function(){
|
|
href.focus();
|
|
}
|
|
});
|
|
});
|
|
});
|
|
})(jQuery);
|
|
</script>
|
|
</div>
|
|
<div class="bottom">
|
|
|
|
<div id="NCBIFooter_dynamic">
|
|
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
|
<component id="Breadcrumbs" label="helpdesk"/>-->
|
|
|
|
</div>
|
|
|
|
<div class="footer" id="footer">
|
|
<section class="icon-section">
|
|
<div id="icon-section-header" class="icon-section_header">Follow NCBI</div>
|
|
<div class="grid-container container">
|
|
<div class="icon-section_container">
|
|
<a class="footer-icon" id="footer_twitter" href="https://twitter.com/ncbi" aria-label="Twitter"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11 {
|
|
fill: #737373;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>Twitter</title>
|
|
<path class="cls-11" d="M250.11,105.48c-7,3.14-13,3.25-19.27.14,8.12-4.86,8.49-8.27,11.43-17.46a78.8,78.8,0,0,1-25,9.55,39.35,39.35,0,0,0-67,35.85,111.6,111.6,0,0,1-81-41.08A39.37,39.37,0,0,0,81.47,145a39.08,39.08,0,0,1-17.8-4.92c0,.17,0,.33,0,.5a39.32,39.32,0,0,0,31.53,38.54,39.26,39.26,0,0,1-17.75.68,39.37,39.37,0,0,0,36.72,27.3A79.07,79.07,0,0,1,56,223.34,111.31,111.31,0,0,0,116.22,241c72.3,0,111.83-59.9,111.83-111.84,0-1.71,0-3.4-.1-5.09C235.62,118.54,244.84,113.37,250.11,105.48Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_facebook" href="https://www.facebook.com/ncbi.nlm" aria-label="Facebook"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>Facebook</title>
|
|
<path class="cls-11" d="M210.5,115.12H171.74V97.82c0-8.14,5.39-10,9.19-10h27.14V52l-39.32-.12c-35.66,0-42.42,26.68-42.42,43.77v19.48H99.09v36.32h27.24v109h45.41v-109h35Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_linkedin" href="https://www.linkedin.com/company/ncbinlm" aria-label="LinkedIn"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>LinkedIn</title>
|
|
<path class="cls-11" d="M101.64,243.37H57.79v-114h43.85Zm-22-131.54h-.26c-13.25,0-21.82-10.36-21.82-21.76,0-11.65,8.84-21.15,22.33-21.15S101.7,78.72,102,90.38C102,101.77,93.4,111.83,79.63,111.83Zm100.93,52.61A17.54,17.54,0,0,0,163,182v61.39H119.18s.51-105.23,0-114H163v13a54.33,54.33,0,0,1,34.54-12.66c26,0,44.39,18.8,44.39,55.29v58.35H198.1V182A17.54,17.54,0,0,0,180.56,164.44Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_github" href="https://github.com/ncbi" aria-label="GitHub"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11,
|
|
.cls-12 {
|
|
fill: #737373;
|
|
}
|
|
|
|
.cls-11 {
|
|
fill-rule: evenodd;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>GitHub</title>
|
|
<path class="cls-11" d="M151.36,47.28a105.76,105.76,0,0,0-33.43,206.1c5.28,1,7.22-2.3,7.22-5.09,0-2.52-.09-10.85-.14-19.69-29.42,6.4-35.63-12.48-35.63-12.48-4.81-12.22-11.74-15.47-11.74-15.47-9.59-6.56.73-6.43.73-6.43,10.61.75,16.21,10.9,16.21,10.9,9.43,16.17,24.73,11.49,30.77,8.79,1-6.83,3.69-11.5,6.71-14.14C108.57,197.1,83.88,188,83.88,147.51a40.92,40.92,0,0,1,10.9-28.39c-1.1-2.66-4.72-13.42,1-28,0,0,8.88-2.84,29.09,10.84a100.26,100.26,0,0,1,53,0C198,88.3,206.9,91.14,206.9,91.14c5.76,14.56,2.14,25.32,1,28a40.87,40.87,0,0,1,10.89,28.39c0,40.62-24.74,49.56-48.29,52.18,3.79,3.28,7.17,9.71,7.17,19.58,0,14.15-.12,25.54-.12,29,0,2.82,1.9,6.11,7.26,5.07A105.76,105.76,0,0,0,151.36,47.28Z">
|
|
</path>
|
|
<path class="cls-12" d="M85.66,199.12c-.23.52-1.06.68-1.81.32s-1.2-1.06-.95-1.59,1.06-.69,1.82-.33,1.21,1.07.94,1.6Zm-1.3-1">
|
|
</path>
|
|
<path class="cls-12" d="M90,203.89c-.51.47-1.49.25-2.16-.49a1.61,1.61,0,0,1-.31-2.19c.52-.47,1.47-.25,2.17.49s.82,1.72.3,2.19Zm-1-1.08">
|
|
</path>
|
|
<path class="cls-12" d="M94.12,210c-.65.46-1.71,0-2.37-.91s-.64-2.07,0-2.52,1.7,0,2.36.89.65,2.08,0,2.54Zm0,0"></path>
|
|
<path class="cls-12" d="M99.83,215.87c-.58.64-1.82.47-2.72-.41s-1.18-2.06-.6-2.7,1.83-.46,2.74.41,1.2,2.07.58,2.7Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M107.71,219.29c-.26.82-1.45,1.2-2.64.85s-2-1.34-1.74-2.17,1.44-1.23,2.65-.85,2,1.32,1.73,2.17Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M116.36,219.92c0,.87-1,1.59-2.24,1.61s-2.29-.68-2.3-1.54,1-1.59,2.26-1.61,2.28.67,2.28,1.54Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M124.42,218.55c.15.85-.73,1.72-2,1.95s-2.37-.3-2.52-1.14.73-1.75,2-2,2.37.29,2.53,1.16Zm0,0"></path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_blog" href="https://ncbiinsights.ncbi.nlm.nih.gov/" aria-label="Blog">
|
|
<svg xmlns="http://www.w3.org/2000/svg" id="Layer_1" data-name="Layer 1" viewBox="0 0 40 40">
|
|
<defs><style>.cls-1{fill:#737373;}</style></defs>
|
|
<title>NCBI Insights Blog</title>
|
|
<path class="cls-1" d="M14,30a4,4,0,1,1-4-4,4,4,0,0,1,4,4Zm11,3A19,19,0,0,0,7.05,15a1,1,0,0,0-1,1v3a1,1,0,0,0,.93,1A14,14,0,0,1,20,33.07,1,1,0,0,0,21,34h3a1,1,0,0,0,1-1Zm9,0A28,28,0,0,0,7,6,1,1,0,0,0,6,7v3a1,1,0,0,0,1,1A23,23,0,0,1,29,33a1,1,0,0,0,1,1h3A1,1,0,0,0,34,33Z"></path>
|
|
</svg>
|
|
</a>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
|
|
<section class="container-fluid bg-primary">
|
|
<div class="container pt-5">
|
|
<div class="row mt-3">
|
|
<div class="col-lg-3 col-12">
|
|
<p><a class="text-white" href="https://www.nlm.nih.gov/socialmedia/index.html">Connect with NLM</a></p>
|
|
<ul class="list-inline social_media">
|
|
<li class="list-inline-item"><a href="https://twitter.com/NLM_NIH" aria-label="Twitter" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st20 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st30 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Twitter</title>
|
|
<g>
|
|
<g>
|
|
<g>
|
|
<path class="st20" d="M192.9,88.1c-5,2.2-9.2,2.3-13.6,0.1c5.7-3.4,6-5.8,8.1-12.3c-5.4,3.2-11.4,5.5-17.6,6.7 c-10.5-11.2-28.1-11.7-39.2-1.2c-7.2,6.8-10.2,16.9-8,26.5c-22.3-1.1-43.1-11.7-57.2-29C58,91.6,61.8,107.9,74,116 c-4.4-0.1-8.7-1.3-12.6-3.4c0,0.1,0,0.2,0,0.4c0,13.2,9.3,24.6,22.3,27.2c-4.1,1.1-8.4,1.3-12.5,0.5c3.6,11.3,14,19,25.9,19.3 c-11.6,9.1-26.4,13.2-41.1,11.5c12.7,8.1,27.4,12.5,42.5,12.5c51,0,78.9-42.2,78.9-78.9c0-1.2,0-2.4-0.1-3.6 C182.7,97.4,189.2,93.7,192.9,88.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st30" cx="124.4" cy="128.8" r="108.2"></circle>
|
|
</g>
|
|
</svg></a></li>
|
|
<li class="list-inline-item"><a href="https://www.facebook.com/nationallibraryofmedicine" aria-label="Facebook" rel="noopener noreferrer" target="_blank">
|
|
<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st10 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st110 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Facebook</title>
|
|
<g>
|
|
<g>
|
|
<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st110" cx="123.6" cy="123.2" r="108.2"></circle>
|
|
</svg>
|
|
</a></li>
|
|
<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<title>Youtube</title>
|
|
<style type="text/css">
|
|
.st4 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
|
|
.st5 {
|
|
fill: #FFFFFF;
|
|
}
|
|
</style>
|
|
<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
|
|
<g transform="translate(0,-952.36218)">
|
|
<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
|
|
</g>
|
|
</svg></a></li>
|
|
</ul>
|
|
</div>
|
|
<div class="col-lg-3 col-12">
|
|
<p class="address_footer text-white">National Library of Medicine<br />
|
|
<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
|
|
Bethesda, MD 20894</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
|
|
<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
|
|
<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
|
|
<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
|
|
<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="col-lg-12 centered-lg">
|
|
<nav class="bottom-links">
|
|
<ul class="mt-3">
|
|
<li>
|
|
<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.nih.gov/">NIH</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.hhs.gov/">HHS</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
|
|
</li>
|
|
</ul>
|
|
</nav>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<!--/.page-->
|
|
</div>
|
|
<!--/.wrap-->
|
|
</div><!-- /.twelve_col -->
|
|
</div>
|
|
<!-- /.grid -->
|
|
|
|
<span class="PAFAppResources"></span>
|
|
|
|
<!-- BESelector tab -->
|
|
|
|
|
|
|
|
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK66010&ncbi_domain=pdqcis&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK66010.2/&ncbi_pagename=Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
|
|
|
|
|
|
<!-- usually for JS scripts at page bottom -->
|
|
<!--<component id="PageFixtures" label="styles"></component>-->
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal104 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/4062932/4209313/4212053/4076480/3921943/3400083/3426610.js" snapshot="books"></script></body>
|
|
</html> |