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For further information, see CMDT Part 39-19: Cancers of the Ureter & Renal Pelvis

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 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


  • Urinary cytology: often positive

  • Intravenous urography and abdominal CT

    • Intraluminal filling defect

    • Unilateral nonvisualization of the collecting system

    • Hydronephrosis

  • Upper urinary tract lesions are accessible for diagnostic biopsy, fulguration, or resection using a ureteroscope


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

  • Endoscopic resection may be indicated in patients who have limited kidney function or who have focal, low-grade cancers

  • Chemoablation with a mitomycin-infused gel can be performed in very select patients with low-grade upper tract lesions

  • Most high-grade and high-volume cancers are excised with robotic, laparoscopic, or open nephroureterectomy (renal pelvic and upper ureteral lesions) or segmental excision of the ureter (distal ureteral lesions)

  • Dual agent adjuvant systemic chemotherapy after nephroureterectomy significantly improved 3-year disease-free survival in a phase 3, randomized trial

  • Like with urothelial bladder cancers, the use of chemotherapy prior to surgery may also improve outcomes

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