Conditions & Treatments

Urothelial Cell Cancer of the Renal Pelvis and Ureter

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OVERVIEW

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.

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Types of Urothelial Cell Cancer of the Renal Pelvis and Ureter

  • Non-Invasive Papillary Urothelial Carcinoma: This type of UTUC is limited to the inner lining of the renal pelvis or ureter and does not invade the deeper layers of tissue.
  • Invasive Urothelial Carcinoma: Invasive UTUC is more aggressive and has penetrated deeper into the wall of the renal pelvis or ureter. It can spread to nearby tissues and organs.

SYMPTOMS & CAUSES

Symptoms

The signs and symptoms of UTUC can include:

  • Blood in the urine (hematuria): One of the most common and noticeable symptoms
  • Pain or discomfort in the side or lower back
  • Frequent urination or a strong urge to urinate
  • Pain during urination
  • Unintentional weight loss
  • Fatigue
  • Swelling in the legs and ankles (edema), if the cancer blocks the flow of urine

Causes & Risk Factors

The exact cause of urothelial cell cancer in the renal pelvis and ureter is not fully understood, but several risk factors may increase the likelihood of developing this cancer. These risk factors include:

  • Smoking: Smoking is a major risk factor for UTUC.
  • Exposure to Chemicals: Certain chemicals, such as those used in the dye and rubber industries, may increase the risk.
  • Chronic Kidney Inflammation: Conditions that cause long-term irritation or inflammation of the kidneys, such as kidney stones or chronic infections, may elevate the risk.
  • Heredity: A family history of UTUC can increase the likelihood of developing the disease.
  • Age and Gender: UTUC is more common in people over 65 and is slightly more prevalent in men than women.

DIAGNOSIS & SCREENING

  • Medical History and Physical Examination: A healthcare provider will begin by taking a detailed medical history and conducting a physical examination. They will ask about symptoms and risk factors.
  • Urinalysis: A urinalysis can help detect the presence of blood or abnormal cells in the urine, which may suggest UTUC.
  • Imaging Tests: Various imaging tests can help visualize the kidneys, renal pelvis, and ureters. These may include:
    • Ultrasound: Uses sound waves to create images.
    • CT (Computed Tomography) Scan: Provides detailed cross-sectional images of the urinary tract.
    • MRI (Magnetic Resonance Imaging): Uses magnetic fields and radio waves to produce detailed images.
  • Cystoscopy: A thin, flexible tube with a camera (cystoscope) is inserted through the urethra to examine the bladder and urethra. In some cases, a ureteroscope can be used to examine the ureters and renal pelvis.
  • Biopsy: If suspicious lesions or abnormalities are found during imaging or cystoscopy, a biopsy may be performed. A small tissue sample is taken for examination under a microscope to confirm the diagnosis and determine the cancer’s stage and grade.

TREATMENTS

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:
    • Nephroureterectomy: This is the most common surgical procedure, where the affected kidney, renal pelvis, and ureter are removed. In some cases, nearby lymph nodes may also be removed.
  • Minimally Invasive Surgery: 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: Chemotherapy may be recommended before or after surgery to target cancer cells that have spread or are at risk of spreading.
  • Radiation Therapy: 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: These newer treatments 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.

OUTLOOK & 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.

However, more advanced cancers that have spread to nearby tissues or lymph nodes may be more challenging to treat. The prognosis is also influenced by the effectiveness of treatment and how well the patient responds to it.

Prevention & Management

Preventing urothelial cell cancer of the renal pelvis and ureter primarily involves minimizing risk factors and adopting a healthy lifestyle. Here are some prevention and management strategies:

  • Smoking Cessation: If you smoke, quitting is one of the most effective ways to reduce the risk of urothelial cell cancer and numerous other health problems.
  • Occupational Safety: If you work in industries where you are exposed to chemicals associated with an increased risk, follow safety guidelines and wear protective equipment.
  • Stay Hydrated: Maintaining good hydration can help reduce the risk of developing kidney stones, which can lead to chronic kidney irritation.
  • Balanced Diet: Eating a well-balanced diet rich in fruits and vegetables may contribute to overall kidney health.
  • Regular Check-ups: Individuals with a family history of UTUC or other risk factors should consider regular check-ups and screenings as advised by their healthcare provider.
  • Healthy Weight: Maintaining a healthy weight through diet and exercise may lower the risk of various cancers, including UTUC.

CONCLUSION

Urothelial cell cancer of the renal pelvis and ureter is a relatively rare but serious form of cancer that affects the upper urinary tract. While the exact causes remain complex and multifactorial, early detection through regular medical check-ups, especially for those with risk factors, is crucial for improving the prognosis.

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