Урология - Tumors

TNM

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single lymph node, <=2 cm at largest point

N2 Metastasis in a single lymph node, >2 cm but <=5 cm at largest point; or multiple lymph nodes, <=5 cm at largest point

N3 Metastasis in a lymph node, >5 cm at largest point

TNM

Distant metastasis (M)

MX - Distant metastasis cannot be assessed

M0 - No distant metastasis

M1 - Distant metastasis

G

Gx hystopatologic gradation can not be evaluated

G1 – highly differentiated

G2 – moderately differentiated

G3 -4 - low-differentiated – nondifferentiated

Symptoms and clinic

Painless haematuria

Frequent urination

Symtom of ”laying of urine atream” ( in case of a tumor on a long leg in projection of bladder triangle)

Pain at lumbal area, elevation of temperature (in case of a tumor infiltrating ureteral orifice and imparing urine outflow)

Asymptomatic

Diagnostics

Cytology. Voided urine cytology is a Pap smear of cells lining the urinary tract than have fallen off into the urine. If the urinary cytology is positive, then transitional cell cancer of the urothelium is almost certainly present. However, cytologic examinations may be negative in up to half of patients with bladder cancer; thus, a negative study does not rule out bladder cancer

Diagnostics

Since transitional cells line the urinary tract starting at the kidney, down the ureter, into the bladder and includes most of the urethra, the entire urinary tract needs to be evaluated for transitional cell cancer. The lining of the kidneys (renal pelvis) and ureters are best evaluated by intravenous pyelogram (IVP) or retrograde pyelogram. An IVP involves an intravenous injection of constrast material which is then filtered out of the blood in into the urine by the kidney. Plain x-rays taken during this process show the uninary tract.

Diagnostics

Office cystoscopy is an essential part of the initial evaluation. A retrograde pyelogram can be performed at the time of cystoscopy.

Typically a retrograde pyelogram is reserved for patients with an intravenous contrast allergy or poor visualization on IVP.

Other diagnostic modalities such as ultrasound, computed tomography, or magnetic resonance imaging may miss small subtle abnormalities.