Ureter & Renal Pelvis Cancer

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

• Differential diagnosis

  • Calculi

  • Blood clots

  • Papillary necrosis

  • Inflammatory or infectious lesions

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

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