Upper Urinary Tract Cancer

At the University of Kansas Cancer Center, our specialized team is dedicated to providing exceptional treatment for all types of urological cancers, including urothelial cell cancer of the renal pelvis and ureter. This cancer is also known as upper tract urothelial carcinoma, or UTUC. Our team tailors treatment strategies, employing advanced methods and diagnostic tools to develop a comprehensive approach to cancer treatments. We are deeply committed to your overall well-being and provide compassionate care to enhance your quality of life.

Compared to the more commonly diagnosed types of bladder cancer, urothelial cell cancer of the renal pelvis and ureter is a relatively rare but serious malignancy that originates in the lining of the upper urinary tract. It often presents with symptoms such as blood in the urine, making early detection crucial for successful treatment. In some cases, surgical intervention is necessary to remove the affected tissue.

Urothelial cell cancer of the renal pelvis and ureter may present as 2 types. Non-invasive papillary urothelial carcinoma is limited to the inner lining of the renal pelvis or ureter and does not invade the deeper layers of tissue. Invasive urothelial carcinoma is more aggressive and has penetrated deeper into the wall of the renal pelvis or ureter. It can spread to nearby tissues and organs.

The signs and symptoms of UTUC can include:

• Blood in the urine (hematuria) is often one of the most common and noticeable symptoms.
• Pain or discomfort in the side or lower back, or during urination, may also occur.
• Frequent urination or a strong urge to urinate may be a sign of UTUC.
• UTUC may also cause unintentional weight loss and fatigue, along with swelling in the legs and ankles (edema), if the cancer blocks the flow of urine.

Several risk factors may increase the likelihood of developing this cancer, including:

• Smoking is a major risk factor for UTUC.
• Exposure to certain chemicals, such as those used in the dye and rubber industries, may increase your risk.
• Chronic kidney inflammation caused by conditions such as kidney stones or chronic infections may elevate your risk.
• A family history of UTUC can increase the likelihood of developing the disease.
• People over age 65 are more likely to receive a UTUC diagnosis.
• Men have a slightly higher rate of UTUC diagnosis compared to women.

A healthcare provider will begin by taking a detailed medical history and conducting a physical examination. They will ask about symptoms and risk factors. From there, additional screening and testing options may include:

• Urinalysis to help detect the presence of blood or abnormal cells in the urine, which may suggest UTUC.
• Imaging tests such as ultrasound, CT scan or MRI to help visualize the kidneys, renal pelvis and ureters.
• Cystoscopy, the use of a thin, flexible tube with a camera (cystoscope) to examine the bladder and urethra. In some cases, a ureteroscope can be used to examine the ureters and renal pelvis.
• A biopsy if suspicious lesions or abnormalities are found during imaging or cystoscopy. A small tissue sample is taken for examination under a microscope to confirm the diagnosis and determine the cancer’s stage and grade.

The choice of treatment for urothelial cell cancer of the renal pelvis and ureter depends on the stage and grade of the cancer, as well as the patient’s overall health. Common treatment options include:

• Surgery to remove affected tissue. Nephroureterectomy is the most common surgical procedure for this type of cancer. The affected kidney, renal pelvis and ureter are removed, and in some cases, nearby lymph nodes also may be removed. Some cases may be treated with minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, which involve smaller incisions and shorter recovery times.
• Chemotherapy may be recommended before or after surgery to target cancer cells that have spread or are at risk of spreading.
• Radiation therapy uses high-energy beams to target and kill cancer cells. It may be used in combination with surgery or chemotherapy in certain situations.
• Immunotherapy and targeted therapy aim to stimulate the immune system to fight cancer or target specific molecules involved in cancer growth. They may be used in advanced cases or in clinical trials.

While urothelial cell cancer of the renal pelvis and ureter is relatively rare, it is a serious form of cancer that affects the upper urinary tract. The exact causes remain complex and multifactorial, making early detection through regular medical check-ups crucial for improving the prognosis.

The outlook for individuals with urothelial cell cancer of the renal pelvis and ureter varies depending on factors such as the cancer stage, grade, and overall health of the patient. Early-stage cancers that are confined to the renal pelvis or ureter tend to have a better prognosis, with a higher chance of cure. More advanced cancers that have spread to nearby tissues or lymph nodes may be more challenging to treat.