Skip to Main Content

Cancers of the ureter and renal pelvis are rare and occur more commonly in patients who have bladder cancer, Balkan nephropathy, or Lynch syndrome, who smoke, or who have a long history of analgesic abuse. The majority are urothelial cell carcinomas. Gross or microscopic hematuria is present in most patients; flank pain secondary to bleeding and obstruction occurs less commonly. As with bladder cancers, urinary cytology is often positive in high-grade cancers. The most common signs identified at the time of CT or intravenous urography include an intraluminal filling defect, unilateral nonvisualization of the collecting system, and hydronephrosis. Ureteral and renal pelvic tumors must be differentiated from calculi, blood clots, papillary necrosis, or inflammatory and infectious lesions. On occasion, upper urinary tract lesions are accessible for biopsy, fulguration, or resection using a ureteroscope. Treatment is based on the site, size, grade, 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). Endoscopic resection may be indicated in patients with limited renal function or focal, low-grade, cancers. Similar to urothelial bladder cancers, use of chemotherapy prior to surgery may improve outcomes.

Aragon-Ching  JB. Challenges and advances in the diagnosis, biology, and treatment of urothelial upper tract and bladder carcinomas. Urol Oncol. 2017 Jul;35(7):462–4.
[PubMed: 28625477]  
Gregg  RW  et al. Perioperative chemotherapy for urothelial carcinoma of the upper urinary tract: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2018 Aug;128:58–64.
[PubMed: 29958631]  
Kim  HS  et al. Immune checkpoint inhibitors for urothelial carcinoma. Investig Clin Urol. 2018 Sep;59(5):285–96.
[PubMed: 30182073]  
Liu  F  et al. Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis. Medicine (Baltimore). 2018 Aug;97(35):e11954.
[PubMed: 30170392]  
Nazzani  S  et al. Survival effect of chemotherapy in metastatic upper urinary tract urothelial carcinoma. Clin Genitourin Cancer. 2019 Feb;17(1):e97–103.
[PubMed: 30337106]  
Rouprêt  M  et al. European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol. 2018 Jan;73(1):111–22.
[PubMed: 28867446]  
Verges  DP  et al. Endoscopic treatment of upper tract urothelial carcinoma. Curr Urol Rep. 2017 Apr;18(4):31.
[PubMed: 28251485]  

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.