0is (carcinoma in situ) is a flat tumor located on the tissue lining. Stage I is classified as cancer formation and the spread from the tissue lining inside the ureter to the connective tissue layer. Stage II is when the cancer spreads to the ureter muscle. Following Stage II is Stage III, characterized by the cancer spreading from the muscle to the fat surrounding the ureter. Stage IV is the final stage of ureter cancer and involves the cancer spreading into a surrounding organ, the layer of fat around the kidney, lymph nodes, or other parts of the body (lung, liver, bone, etc.) Other classifications of transitional cell cancer of the ureter include localized, regional, metastatic, and recurrent. Localized means that the cancer has remained at the point of origin (ureter). Regional indicates that the cancer has spread to tissues, lymph nodes, or blood vessels in the vicinity. Metastatic cancer means that it has spread to other parts of the body. Recurrent means that the cancer has returned after treatment has been completed; this can occur in the same location or other parts of the body. Treatment and management Treatment methods include surgery, chemotherapy, radiation therapy and immunotherapy. Treatment options vary based on the size and location of the tumor, how aggressive the cancer cells are, and the patient's lifestyle and expectations. After a diagnosis of ureteral cancer, surgery is oftentimes recommended to help remove the infected ureter. For early stage ureteral patients, removing only a portion of the ureter can be successful, whereas in more advanced cases full removal of the ureter as well as the associated kidney (nephroureterectomy) and part of the bladder is sometimes necessary. In less advanced cases where the cancer is only on the surface of the ureter, electrosurgery or laser therapy may be performed to remove the affected cells. Electrosurgery uses an electric current, whereas laser therapy involves passing a ureteroscope through the bladder and into the urethra where a beam of the laser is used to destroy the cells. Chemotherapy has many different uses in treating ureteral cancer. Prior to surgery, chemotherapy is sometimes used to help shrink the tumor so that it can be more easily removed. Chemo may also be used in more advanced cases to control the symptoms and side effects of the cancer. After surgery to remove the tumor, a single dose of chemotherapy injected into the bladder is