Urothelial cancer refers to a cancer of the lining of the urinary system. While most urothelial cancers (approximately 90-95%) arise in the bladder, upper tract urothelial cancer (UTUC) arises in the lining of the kidney (called the renal pelvis) or the ureter (the long, thin tube that connects that kidney to the bladder).
In addition to the signs of bladder cancer, individuals with UTUC may also experience pain in the upper abdomen or mid-back in the region of the kidney. UTUCs can block the ureter or kidney, causing blockage of the kidney (known as hydronephrosis), and they can even affect kidney function in some patients.
In general, low-grade tumors are not invasive and very rarely spread from the kidney or ureter to other sites. However, they often recur in the kidney, ureter and bladder. Management involves biopsy and ablation (removal by burning with laser or cautery) of the tumour through a camera (ureteroscope) that is passed into the ureter through the bladder. It is important to try to preserve the kidney, but it may need to be removed if the tumour is too extensive.
If a patient has a low-grade UTUC, there are several treatment options:
This is a minor surgery in which a doctor uses a small camera and a laser, or electrocautery to destroy the tumor. For a larger tumor, the doctor may remove it with small instruments and cameras placed through a small incision in the patient’s side. Because UTUC often recurs, patients often have multiple ureteroscopies in the first year after they are diagnosed to see if the disease has returned.
This surgery removes the whole kidney and ureter and a little piece of the bladder.
This surgery is when just a part of the ureter may be removed and the remaining, uninvolved parts of the ureter are sewn back together.
For low-grade UTUC, there are a few medications that may be instilled in the kidney, ureter or bladder. One option is a therapy that combines chemotherapy and an innovative gel technology. The solution is liquid when chilled but turns into a gel at body temperature. Unlike typical chemotherapy that goes everywhere in your body, the gel is directed to the area inside the body where the tumors are located. The gel stays in place for up to 4 to 6 hours.
High-grade UTUC has the potential to spread from the kidney or ureter to lymph nodes, lung and bone. It is most often treated with surgical removal of the kidney and ureter – an operation called radical nephroureterectomy.
Due to the high risk of distant spread, it may also be suggested that a patient receive systemic chemotherapy either before or after surgery, to reduce the risk of recurrence. It is often advantageous to give chemotherapy before surgery because the kidney function will decrease after removal of the kidney which may affect the ability to give the chemotherapy. Where appropriate these cancers could be managed, with input from a multidisciplinary team.
Bladder Cancer Canada has produced a helpful Guidebook with information about UTUC, how it’s diagnosed and the treatment options available. You can download a free copy of our Guidebook. We also host a moderated public Discussion Forum, where you can ask questions, share your experiences and read about the experiences of others.
We encourage you to contact Bladder Cancer Canada for support if you have upper tract urothelial cancer by email or by calling 1-866-674-8889.
