The standard staging system is the Tumor, Node, Metastasis (TNM) system, which encompasses the status of the primary tumor (T), lymph nodes (N), and metastases (M). The eighth edition of the American Joint Committee on Cancer Staging Manual is still currently applicable for TNM staging of UCs [13]. Radical cystectomy with pelvic lymphadenectomy remains the reference standard treatment for MIBC [14]. Neoadjuvant cisplatin-based combination chemotherapy is increasingly being used in these patients and has been shown to improve disease-specific and overall survival compared with surgery alone [15,16]. Alternatively, bladder preservation with concurrent chemoradiotherapy and maximal transurethral resection of bladder tumor (TURBT) is also now included as a category 1 recommendation for localized MIBC in National Comprehensive Cancer Network guidelines [17]. Moving forward, immune-checkpoint inhibitors and molecular-profiling technologies hold the potential to fundamentally change management of bladder cancer [18]. For patients with UTUC with nonmetastatic disease and a normal contralateral kidney, traditionally, standard treatment was an open radical nephroureterectomy with bladder cuff excision. More recent systemic evidence review shows equivalent oncologic outcomes for open and minimally invasive (laparoscopic, hand-assisted laparoscopic, robot-assisted laparoscopic) approaches [8,19]. In a subset of carefully selected patients, less invasive approaches such as kidney sparing surgery or ablation may be suitable alternatives [8,20]. The principal task of imaging is to characterize the site of known UC in addition to evaluating for additional secondary sites in the ureters or bladder, extravesical/ureteral spread, and nodal and distant metastases [21]. Many patients may have already had imaging during the workup of hematuria. Some local practice patterns do not routinely administer intravenous (IV) contrast to renal transplant patients.
Pretreatment Staging of Urothelial Cancer. The standard staging system is the Tumor, Node, Metastasis (TNM) system, which encompasses the status of the primary tumor (T), lymph nodes (N), and metastases (M). The eighth edition of the American Joint Committee on Cancer Staging Manual is still currently applicable for TNM staging of UCs [13]. Radical cystectomy with pelvic lymphadenectomy remains the reference standard treatment for MIBC [14]. Neoadjuvant cisplatin-based combination chemotherapy is increasingly being used in these patients and has been shown to improve disease-specific and overall survival compared with surgery alone [15,16]. Alternatively, bladder preservation with concurrent chemoradiotherapy and maximal transurethral resection of bladder tumor (TURBT) is also now included as a category 1 recommendation for localized MIBC in National Comprehensive Cancer Network guidelines [17]. Moving forward, immune-checkpoint inhibitors and molecular-profiling technologies hold the potential to fundamentally change management of bladder cancer [18]. For patients with UTUC with nonmetastatic disease and a normal contralateral kidney, traditionally, standard treatment was an open radical nephroureterectomy with bladder cuff excision. More recent systemic evidence review shows equivalent oncologic outcomes for open and minimally invasive (laparoscopic, hand-assisted laparoscopic, robot-assisted laparoscopic) approaches [8,19]. In a subset of carefully selected patients, less invasive approaches such as kidney sparing surgery or ablation may be suitable alternatives [8,20]. The principal task of imaging is to characterize the site of known UC in addition to evaluating for additional secondary sites in the ureters or bladder, extravesical/ureteral spread, and nodal and distant metastases [21]. Many patients may have already had imaging during the workup of hematuria. Some local practice patterns do not routinely administer intravenous (IV) contrast to renal transplant patients.