Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Eastern Cooperative Oncology Group (ECOG) performance status calculator is designed to evaluate a patient's functional ability and categorize it into a specific score from 0 to 5. This quantitative measure helps clinicians make informed decisions about treatment based on the patient's capacity for daily activities and self-care. Here's how it operates:

The user provides input by selecting the description that best matches the patient's current condition from a list of predefined options. These options encapsulate various levels of activity and ability:

- A patient who is "Fully active, able to carry on all pre-disease performance without restriction" is assigned a score of ECOG PS 0. This indicates that the patient is not limited in any capacity by their disease.
- If a patient is "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework, office work," they receive an ECOG PS 1. This means the patient can perform some self-care and work activities but faces restrictions with strenuous tasks.
- "Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours" corresponds to an ECOG PS 2. This reflects moderate impairment, where the patient is active for the majority of the day but not capable of work activities.
- A patient who is "Capable of only limited self-care, confined to bed or chair more than 50% of waking hours" gets an ECOG PS 3. This score denotes significant limitation, as the patient is mobile for less than 50% of the time and requires assistance for most activities.
- With "Completely disabled, cannot carry on any self-care, totally confined to bed or chair," the patient is categorized as ECOG PS 4, indicating severe impairment and complete dependency.
- Finally, if the patient is "Dead," they are assigned an ECOG PS 5.

These score assignments help standardize assessments, providing an objective measure of a patient's status which can be pivotal in guiding medical decisions and evaluating treatment options.

The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the ECOG score, is a widely used tool in oncology to assess a patient's level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.). It is applicable to patients with cancer of any type and at any stage.

The ECOG score ranges from 0 to 5, with 0 indicating fully active and able to carry on all pre-disease activities without restriction, and 5 indicating death. The score is used to determine a patient's prognosis, assess how a disease is progressing, and to determine appropriate treatment strategies. It is also often used in clinical trials to assess eligibility and to monitor patient progress.

There are no specific exclusion criteria for the use of the ECOG score, but it is important to note that it is a subjective measure and may not fully capture a patient's functional status. It is also less useful in patients with fluctuating or rapidly changing conditions.

Eastern Cooperative Oncology Group performance status (ECOG score)

The Karnofsky Performance Scale (KPS) provides a practical method to evaluate a patient's functional ability and the extent of care required based on their health status. The scale ranges from 0% to 100%, where higher percentages signify better functional capacity and health.

This tool involves selecting a descriptive statement that best reflects a patient's current condition from a predefined list. Each statement is connected to a specific KPS percentage that indicates the patient’s ability to perform daily activities and their dependency levels. Here’s how the assessment works:

- When a patient is described as "Normal, no complaints, no evidence of disease," this is assessed as KPS 100%. At this level, the individual can engage in all regular activities, including work, without needing special care.

- If a patient can "carry on normal activity" but exhibits "minor signs or symptoms of disease," they are scored at KPS 90%, indicating the capability to maintain routine activities without requiring special care.

- A description of "Normal activity with effort, some signs or symptoms of disease" aligns with KPS 80%. This suggests the patient can still carry out normal activities but might require some extra effort.

- When the condition reflects "Cares for self, unable to carry on normal activity or to do active work," it corresponds to KPS 70%. The patient can handle most personal needs independently but may need occasional assistance.

- "Requires occasional assistance but is able to care for most personal needs" is rated as KPS 60%, implying increased dependency on assistance though the patient remains mostly self-sufficient.

- At KPS 50%, for conditions described as "Requires considerable assistance and frequent medical care," the patient can live at home but needs considerable help with personal care.

- As the need for care intensifies, with descriptions like "Disabled, requires special care and assistance," the KPS drops to 40%. This marks a significant deterioration in self-care ability.

- "Severely disabled, hospital admission is indicated, death not imminent" corresponds to KPS 30%, highlighting a need for hospitalization without immediate life-threatening conditions.

- For those "Very sick," necessitating hospital admission and "active supportive treatment," the KPS is 20%, indicating critical care requirements.

- At KPS 10%, "Moribund" denotes an inability to care for oneself, with urgent need for hospital-level care and a poor prognosis.

- Lastly, "Dead" is considered as KPS 0%.

This scale is instrumental in providing a quick overview of a patient's ability to function independently and their need for medical support, thereby facilitating better care planning and resource allocation.

The Karnofsky Performance Status Scale (KPSS) is a clinical calculator used primarily in patients with cancer. It is a simple, numerical scale that measures a patient's functional status, ability to perform daily activities, and overall quality of life. The KPSS ranges from 0 (indicating death) to 100 (indicating perfect health). 

The clinical utility of the KPSS is to assess a patient's prognosis, determine appropriate treatment strategies, and monitor changes in a patient's condition over time. It is particularly useful in oncology for determining eligibility for certain treatments, such as chemotherapy or surgery, and for predicting survival outcomes. 

There are no specific exclusion criteria for the use of the KPSS. However, it is less useful in patients with non-cancer illnesses or in those with cognitive impairment who may not be able to accurately self-report their functional status.

Karnofsky Performance Scale

The TNM classification calculator for upper urinary tract urothelial cell carcinoma determines the cancer stage based on user inputs regarding tumor characteristics, lymph node involvement, and the presence of distant metastasis. Each user input corresponds to a predefined category within three classification systems: tumor classification, lymph node classification, and distant metastasis classification. The algorithm checks these inputs against established criteria to assign an overall stage to the cancer, denoting its progression.

Inputs:
- Tumor Classification (T): Indicates the extent and characteristics of the primary tumor.
  - Tx: Primary tumor cannot be assessed
  - T0: No evidence of primary tumor
  - Ta: Non-invasive papillary carcinoma
  - Tis: Carcinoma in situ
  - T1: Tumor invading subepithelial connective tissue
  - T2: Tumor invading muscularis propria
  - T3: Tumor invading beyond muscularis into peripelvic fat or renal parenchyma (for renal pelvis) or periureteric fat (for ureter)
  - T4: Tumor invading adjacent organs or through the kidney into perinephric fat

- Lymph Node Classification (N): Describes the extent of spread to nearby lymph nodes.
  - Nx: Regional lymph nodes cannot be assessed
  - N0: No regional lymph node metastasis
  - N1: Metastasis in a single lymph node <= 2 cm in the greatest dimension
  - N2: Metastasis in a single lymph node > 2 cm or multiple lymph nodes

- Distant Metastasis (M): Indicates whether cancer has spread to distant parts of the body.
  - M0: No distant metastasis
  - M1: Distant metastasis present

Computation:
1. Evaluate the input tumor classification (T) against predefined categories to determine one of the following variables: A, B, C, D, E, F, G, H.
2. Evaluate lymph node classification (N) to determine one of the variables: I, J, K, L.
3. Evaluate distant metastasis (M) to determine either M or N.

Using these evaluations, the algorithm assesses the combined inputs to assign a cancer stage:
- Stage 0a: If Ta is present with N0 and M0.
- Stage 0is: If Tis is present with N0 and M0.
- Stage I: If T1 is present with N0 and M0.
- Stage II: If T2 is present with N0 and M0.
- Stage III: If T3 is present with N0 and M0.
- Stage IV: If
  - T4 is present with Nx, N0, and M0
  - T1, T2, T3, or T4 is present with N1 or N2 and M0
  - T1, T2, T3, or T4 present with any N category and M1
- If none of these exact combinations are met, the result will notify that the stage cannot be fully assessed.

Output:
- The calculator returns a string indicating the cancer stage, or a message suggesting all inputs must be made if no stage determination is possible. The stage of the cancer, described through classic categories, indicates the severity and spread of cancer within and potentially beyond the upper urinary tract.

The calculator in question is the TNM Classification for Upper Urinary Tract Urothelial Cell Carcinoma. TNM stands for Tumor, Node, Metastasis, and it is a globally recognized standard for classifying the extent of spread of cancer. 

This specific TNM classification applies to patients diagnosed with upper urinary tract urothelial cell carcinoma, a type of cancer that originates in the urothelial cells lining the upper urinary tract, which includes the renal pelvis and the ureters.

The clinical utility of this calculator is to stage the cancer, which is crucial for determining the appropriate treatment strategy and for predicting patient prognosis. The TNM classification takes into account the size and extent of the primary tumor (T), whether the cancer has spread to nearby lymph nodes (N), and whether it has metastasized, or spread to other parts of the body (M).

There are no specific exclusion criteria for the use of the TNM classification. However, it should be noted that this system is not used for all types of cancer, and its application requires a thorough clinical and often pathological evaluation of the patient.

TNM classification for upper urinary tract urothelial cell carcinoma

The Modified Glasgow Prognostic Score (mGPS) is a key tool in predicting cancer outcomes, relying on the assessment of two biochemical markers: C-reactive protein (CRP) and albumin. This score helps to categorize the prognosis into three levels: good, intermediate, and poor.

To compute the mGPS:

- C-reactive protein is evaluated first. Two options are considered:  
  - If the CRP is less than or equal to 10 mg/L, it indicates lower systemic inflammation.
  - If the CRP is greater than 10 mg/L, it signifies higher inflammation levels.

- Albumin is the second marker, with two possibilities:  
  - An albumin level of less than 3.5 g/dL [35 g/L] suggests malnutrition or potential inflammatory conditions.
  - An albumin level equal to or greater than 3.5 g/dL [35 g/L] signifies a normal nutritional status and protein reserves.

The mGPS score is derived based on the following systematic interpretation:

- If CRP is <= 10 mg/L, regardless of the albumin level, the score is mGPS 0, corresponding to a good prognosis. This combination indicates a low level of inflammation, which is a favorable signal in cancer outcomes.
 
- If CRP is > 10 mg/L and albumin is >= 3.5 g/dL [35 g/L], the score is mGPS 1, associated with an intermediate prognosis. This combination suggests elevated inflammation yet with sufficient nutritional status, resulting in a moderate outlook.

- If CRP is > 10 mg/L and albumin is < 3.5 g/dL [35 g/L], the result is mGPS 2, indicating a poor prognosis. This reflects high inflammation levels coupled with low albumin, suggesting a more severe condition.

Here's a concise summary table for reference:

| C-reactive Protein | Albumin               | mGPS Score | Interpretation          |
|---------------------|-----------------------|-------------|-----------------------|
| <= 10 mg/L          | < 3.5 or >= 3.5 g/dL  | 0           | Good prognosis         |
| > 10 mg/L           | >= 3.5 g/dL           | 1           | Intermediate prognosis |
| > 10 mg/L           | < 3.5 g/dL            | 2           | Poor prognosis         |

This systematic approach enables healthcare providers to improve risk stratification in cancer patients, allowing for more tailored treatment planning.

The Modified Glasgow Prognostic Score (mGPS) is a clinical calculator used in the field of oncology to predict the prognosis of patients with cancer. It is applicable to a wide range of cancer types and stages, making it a versatile tool for clinicians. The mGPS is based on two simple, routinely measured inflammatory markers: C-reactive protein (CRP) and albumin levels. 

The clinical utility of the mGPS lies in its ability to stratify patients into different risk groups based on their inflammatory response to cancer. This can guide clinicians in making decisions about treatment strategies and follow-up plans. It can also provide valuable prognostic information to patients and their families.

There are no specific exclusion criteria for the use of the mGPS. However, it should be noted that the score may not be as accurate in patients with concurrent inflammatory or infectious conditions, as these can also affect CRP and albumin levels. Additionally, the mGPS may not be applicable to patients with rare types of cancer or those with very early or very advanced disease, as it has not been extensively validated in these groups.

Modified Glasgow Prognostic Score for cancer outcomes (mGPS)

Upper urinary tract urothelial carcinoma

Watchful waiting

Clinical assessment

Histopathology

Adjuvant therapy

Adjuvant therapy, nivolumab

Pelvicalyceal chemotherapy

Kidney-sparing interventions

Radical nephroureterectomy

Diagnostic imaging

Surveillance after nephroureterectomy

Urinary tract washing

Definitive therapy

Definitive therapy, first-line therapy

Risk assessment

Diagnostic endoscopy

Definitive therapy (maintenance therapy)

Pelvicalyceal bacillus Calmette-Guérin

Pelvicalyceal BCG

Surveillance after kidney-sparing management

Neoadjuvant therapy

General counseling

Adjuvant therapy, platinum-based

Definitive therapy, second-line therapy

Laboratory testing

Palliative care

Updated 2024 EAU guidelines for the diagnosis and management of upper urinary tract urothelial carcinoma


Upper urinary tract urothelial carcinoma

Guidelines

Key sources