Imaging and staging of transitional cell carcinoma: part 2, upper urinary tract

Transitional cell carcinoma (TCC) of the upper urinary tract is a common malignancy affecting the genitourinary tract. It is commonly multifocal with a high incidence of recurrence requiring rigorous urothelial surveillance. In this article, we discuss the epidemiology, pathologic characteristics, and patterns of tumor spread. We illustrate and discuss the role of imaging in the diagnosis, staging, and surveillance of TCC of the renal pelvis and the ureter.

The hallmark of TCC is multiplicity and recurrence. Nearly 2-4% of patients with bladder cancer develop upper tract TCC, but 40% of patients with upper tract TCC develop bladder cancer. Diagnosis of upper tract TCC is heavily dependent on imaging. Understanding the appearances of upper tract TCC on the different imaging techniques used is important in the accurate interpretation of imaging studies. Newer techniques such as CT urography are now increasingly used instead of conventional excretory urography in the surveillance of the upper tract in patients with bladder cancer.