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 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

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

Treatment

• 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