Upper Tract Urothelial Tumors

—Specialisation

Quick Answer

Quick Answer: Upper Tract Urothelial Tumours

What is an upper tract urothelial tumour?+

An upper tract urothelial tumour is a cancer arising in the lining (urothelium) of the renal pelvis or ureter. It is relatively uncommon and accounts for around 5% of urothelial cancers.

Who is at risk for upper tract urothelial cancer?+

Most patients are aged 65–80. Smoking is the strongest risk factor; occupational exposure to industrial dyes, rubber, and certain chemicals also raises risk. Men are affected three times more often than women.

How is it diagnosed?+

Diagnosis involves CT urography or MR urography, urinary cytology, and ureteroscopy with biopsy. Accurate staging and grading guide treatment selection.

How is upper tract urothelial cancer treated?+

Low-grade, low-stage tumours can often be managed with kidney-sparing endoscopic ablation or segmental resection. High-grade or invasive tumours typically require radical nephroureterectomy with bladder-cuff excision.

Upper Tract Urothelial Tumours are relatively uncommon malignancies arising in the lining of the renal pelvis or ureter. They typically present between ages 65 and 80, occur three times more often in men than in women, and around 40% are non-invasive at the time of diagnosis.

Causes

Approximately 95% of upper-tract urothelial tumours are transitional cell carcinomas (TCC). Renal pelvis tumours account for the remaining ~5%. There are many factors that could increase the risk of TCC and so the urinary, as the following.

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Tobacco smoking as a major contributing factor

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More consuming coffee, about more than 7 times a day, to a slight percentage

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Analgesic abuse or long term exposure to it

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Heredity

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Occupational exposure of the patient towards the agents, in the fields like tar, plastic and petrochemical industries

Symptoms

The symptoms for this medical condition are usually restricted. Patients may present with local urinary symptoms as well as systemic features.

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Visible or microscopic blood in the urine (haematuria) is the most common symptom, occurring in 70–80% of patients.

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Anorexia

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Malaise

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Fever

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Weight loss

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Fatigue

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Night sweat

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Cough

Diagnosis

Diagnosis for the medical condition of urothelial tumors in the upper tract is done through imaging studies. One or more than one of the following tests are conducted to diagnose the condition.

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IVP or Intravenous Pyelography, for evaluation of the upper urothelial tract

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Computer Tomography or CT

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MRI scanning

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Ureteroscopy to visualize the tumor directly

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Cytopathology with samples of the urine

Diagnostic study is performed to understand the grade of the medical condition. Grade and stages of the condition give clear clues of the severity of the condition and also how to treat the condition. The condition can be in any grade ranging from grade 1, 2 or 3. When it comes to the staging, the condition can be any of Tis, Ta, T1, T2, T3, T4, N0, N1, N2, N3, M0 and M1.

Treatments Available

There are two kinds of medical therapies are considered for the treatment of the urothelial tumors of the upper tract. Treatment is usually suggested according to the severity and intensity of the disease.

Localised disease

For localised diseases there are certain kinds of treatments are recommended, as the following.

Radical Nephroureterectomy

Radical nephroureterectomy is considered as a gold standard treatment to cure the localised disease conditions, with the bladder cuff bladder. The location of the tumor can be anywhere within the upper urinary tract. In this procedure, distal ureter and bladder cuff are removed and thereby benefiting with the relieving symptoms. The important consideration here is that there should not be delay between the diagnosis and tumor removal, because the risk of progression of the disease and increase of the risk will be more.

Surgery

Conservative surgery is recommended for the UTUC with low risk. It can preserve the upper urinary renal unit. The choice of which technique has to be used for the surgery depends on the many constraints like, anatomical location, technical constraints and also the overall experience in the surgeries for the surgeon.

Ureteroscopy

Endoscopic ablation or Ureteroscopy is a very selective option chosen by the doctor, as the choice depends on different situations and cases.

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Availability of the flexible ureteroscope, pilers and laser generators, needed for the biopsies.

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When the complete resection of the tumor is strongly recommended or advocated

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The patient is informed with stringent surveillance and need for close surveillance.

Segmental Resection

Segmental ureteral resection is recommended for specific definitive grade analysis and staging and well preserve of the kidney. The treatment is indicated or preferred for the low-grade tumors, non-invasive tumors or mid-ureter, which is impossible to be removed through endoscopic means, as well as for the invasive tumors and high-grade tumors, in the conditions, when renal sparing surgery is selected.