TY  - CHAP
M1  - Book, Section
TI  - Cancers of the Ureter & Renal Pelvis
A1  - Dall’Era, Marc A.
A2  - Papadakis, Maxine A.
A2  - McPhee, Stephen J.
A2  - Rabow, Michael W.
A2  - McQuaid, Kenneth R.
PY  - 2023
T2  - Current Medical Diagnosis & Treatment 2023
AB  - 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.  Upper  urinary  tract  lesions  are  accessible  for  diagnostic  biopsy,  fulguration,  or  resection  using  a  ureteroscope.  Treatment  is  based  on  the  site,  size,  grade,  depth  of  penetration,  and  number  of  cancers  present.  Endoscopic  resection  may  be  indicated  in  patients  with  limited  renal  function  or  focal,  low-grade,  cancers.  Chemoablation  with  a  mitomycin  infused  gel  can  be  performed  in  very  select  patient  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).  A  phase  3,  randomized  trial  demonstrated  significantly  improved  3-year  disease-free  survival  with  dual  agent  adjuvant  systemic  chemotherapy  after  nephroureterectomy.  Like  with  urothelial  bladder  cancers,  use  of  chemotherapy  prior  to  surgery  may  also  improve  outcomes  and  remains  under  investigation.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1193162647
ER  -