Skip to content

Grading and staging of upper tract urothelial cancer

If cancer cells are found during any of your tests, your doctor will need to know the grade and stage of the tumour so your team of health professionals can develop the best treatment plan for you. The grade lets your doctor know how quickly the cancer might grow and spread while the stage describes its size and whether it has spread beyond the original site.


Upper tract urothelial cancers are graded as follows:

  • Papillary urothelial neoplasia of low malignant potential (PUNLMP) – very slow growing and rarely recur or spread.
  • low grade – the cancer cells are usually slow-growing and are less likely to invade and spread.
  • high grade – the cancer cells look highly abnormal, they grow quickly and are more likely to spread.

The grade will tell your doctor how likely the cancer will be to recur and therefore determine the treatment you required. Most UTUC will need follow-up cystoscopies and/or ureteroscopies, imaging and urine tests annually.


The most common staging system for UTUC is the TNM system. In this system, letters and numbers are used to describe the cancer, with higher numbers indicating larger size or spread.

T stands for tumourTa, Tis and T1 are non-muscle-invasive cancer, while T2, T3 and T4 are muscle-invasive cancer.
N stands for nodesN0 means the cancer has not spread to the lymph nodes, while N1, N2 and N3 indicate that it has spread to lymph nodes.
M stands for metastasisM0 means the cancer has not spread to distant parts of the body, while M1 means it has spread to distant parts of the body.

Featured resources

Understanding Upper Tract Urothelial Cancer

Download PDF

Understanding Rare and Less Common Cancers

Download PDF

This information is reviewed by

This information was last reviewed February 2021 by the following expert content reviewers: the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Consumer Advisory Panel; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Dr Tom Ferguson, Medical Oncologist, Fiona Stanley Hospital, Perth, WA; Prof Dickon Hayne, UWA Medical School, The University of Western Australia, and Head, Urology, South Metropolitan Health Service, WA; Steven Jones-Evans, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Carlo Yuen, Urologist, St Vincent’s Hospital, Sydney, NSW.