It has been estimated that 70% to 85% of UC of the bladder is nonmuscle invasive at presentation [3]. Invasion of the muscularis propria and beyond, termed muscle- invasive bladder cancer (MIBC), increases the risk for more distant spread. The most common metastatic sites for MIBC include lymph nodes, bone, lung, liver, and peritoneum [6]. UTUC disseminate via lymphatic and hematogenous spread as well as direct extension. The most common sites of metastases for UTUC are lungs, liver, bones, and lymph nodes. A greater proportion of UTUCs are invasive at diagnosis, compared with UC of the bladder, at approximately two- thirds, and multifocal disease has been reported in approximately 25% to 30% of UTUCs at the time of diagnosis [7,8]. UTUC is approximately twice as common in men than women [5] compared with bladder cancer, which is 4 times as common in men. Presenting complaint in 75% to 95% of patients with UTUC is hematuria. Risk factors for developing UC of the bladder and UTUC are similar, contributing to the field exposure principle. Bladder lymph node mapping has demonstrated the complexity and extent of bladder lymphatic drainage. Drainage extends beyond the external iliac vessels and obturator fossa, included in a limited pelvic nodal dissection, to also involve the internal iliac and common iliac vessels up to the uretero-iliac crossing and occasionally extending to the inferior mesenteric artery [9]. Traditionally, lymph nodes have been considered suspicious based on increased size, however, newer MRI techniques and fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT can improve malignancy detection in subcentimeter-sized nodes [10-12]. Reprint requests to: publications@acr.org Pretreatment Staging of Urothelial Cancer UC is staged by its extent at presentation and graded as either low grade or high grade.
Pretreatment Staging of Urothelial Cancer. It has been estimated that 70% to 85% of UC of the bladder is nonmuscle invasive at presentation [3]. Invasion of the muscularis propria and beyond, termed muscle- invasive bladder cancer (MIBC), increases the risk for more distant spread. The most common metastatic sites for MIBC include lymph nodes, bone, lung, liver, and peritoneum [6]. UTUC disseminate via lymphatic and hematogenous spread as well as direct extension. The most common sites of metastases for UTUC are lungs, liver, bones, and lymph nodes. A greater proportion of UTUCs are invasive at diagnosis, compared with UC of the bladder, at approximately two- thirds, and multifocal disease has been reported in approximately 25% to 30% of UTUCs at the time of diagnosis [7,8]. UTUC is approximately twice as common in men than women [5] compared with bladder cancer, which is 4 times as common in men. Presenting complaint in 75% to 95% of patients with UTUC is hematuria. Risk factors for developing UC of the bladder and UTUC are similar, contributing to the field exposure principle. Bladder lymph node mapping has demonstrated the complexity and extent of bladder lymphatic drainage. Drainage extends beyond the external iliac vessels and obturator fossa, included in a limited pelvic nodal dissection, to also involve the internal iliac and common iliac vessels up to the uretero-iliac crossing and occasionally extending to the inferior mesenteric artery [9]. Traditionally, lymph nodes have been considered suspicious based on increased size, however, newer MRI techniques and fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT can improve malignancy detection in subcentimeter-sized nodes [10-12]. Reprint requests to: publications@acr.org Pretreatment Staging of Urothelial Cancer UC is staged by its extent at presentation and graded as either low grade or high grade.