Renal Pelvis, Ureter, Bladder, Urethra (Urinary Tract)

  • Laterality
    A factor for renal pelvis and ureter, but not for bladder and urethra
  • Field effect or implantation
    A special issue for lower urinary tract tumors. If a tumor starts in the renal pelvis and through the urine flow eventually deposits or implants farther down the urinary tract (bladder, for example), are these the same primary or different primaries?
  • Multiple tumors
    In the bladder, multiple tumors are considered a single primary, but what if the multiple tumors are spread along the lower urinary tract surfaces?
  • Transitional epithelium / urothelium
    The International Society of Urologic Pathologists began promoting the term urothelium as preferred terminology about 1998, but the current nomenclature has not been adopted by all pathologists and causes confusion for coders.
  • Papillary carcinoma of low malignant potential
    Is this reportable or not? There has been much discussion about this diagnosis and the standards setters are are trying to finalize clear and complete instruction for guiding registrars to report or not report these tumors. As the ISUP preferred terminology takes hold, papillary carcinoma of low malignant potential is an increasingly used term. Historically we have reported the papillary carcinoma, grade I/III tumors, but as pathologists increasingly use the term low malignant potential to describe these tumors, it takes them off our reportable list—they are not even in situ based on this term. We will provide clear instruction on how to proceed with these tumors for cases diagnosed 1/1/07 and after.
    • Papillary carcinoma - grade I/III
      A former name for a segment of this new spectrum of bladder tumors
    • Papilloma
      A benign diagnosis that is merged into the low malignant potential bladder tumors
  • Papillary versus flat tumor
    Clear definitions and instructions are needed on how to code these entities
  • In situ versus non-invasive
    Largely a staging issue (TNM Ta versus T0), but terminology gets confusing when the registrar tries to code histology and behavior
  • In-situ and invasive
    Another issue of combination behaviors
  • Non-invasive and invasive
    Another issue of combination behaviors
  • Time interval between diagnoses
    When do (or should) recurrent bladder tumors be counted as a new primary cancer?