Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 39-19: Cancers of the Ureter & Renal Pelvis + Key Features Download Section PDF Listen +++ ++ 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 with a long history of analgesic abuse Persons with Lynch syndrome + Clinical Findings Download Section PDF Listen +++ ++ Gross or microscopic hematuria in most Flank pain secondary to bleeding and obstruction less common + Diagnosis Download Section PDF Listen +++ ++ Urinary cytology: often positive in high-grade cancers 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 Download Section PDF Listen +++ ++ 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