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Key Features

  • Most cancers of the ureter and renal pelvis are urothelial cell carcinomas

  • Rare; occur more commonly in

    • Persons with bladder cancer

    • Smokers

    • Persons with Balkan nephropathy

    • Persons exposed to Thorotrast (a contrast agent with radioactive thorium in use until the 1960s)

    • Persons with a long history of analgesic abuse

    • Persons with Lynch syndrome

Clinical Findings

  • Gross or microscopic hematuria in most

  • Flank pain secondary to bleeding and obstruction less common

Diagnosis

  • Urinary cytology: often positive

  • Intravenous urography and abdominal CT

    • Intraluminal filling defect

    • Unilateral nonvisualization of the collecting system

    • Hydronephrosis

  • On occasion, upper urinary tract lesions are accessible for biopsy, fulguration, or resection using a ureteroscope

  • Differential diagnosis

    • Calculi

    • Blood clots

    • Papillary necrosis

    • Inflammatory or infectious lesions

Treatment

  • Treatment is based on the site, size, depth of penetration, and number of cancers present

  • Most are excised with laparoscopic or open nephroureterectomy (renal pelvic and upper ureteral lesions) or segmental excision of the ureter (distal ureteral lesions)

  • Direct biopsy, fulguration, or resection is sometimes possible using a ureteroscope

  • Endoscopic resection indicated in patients with limited kidney function and in the management of focal, low-grade, upper tract cancers

  • Similar to urothelial bladder cancers, the use of chemotherapy prior to surgery may improve outcomes

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