Urothelial cancer refers to a cancer of the lining of the urinary system. While the majority of urothelial cancers (approximately 90-95%) arise in the bladder, upper tract urothelial cancers (UTUCs) arise 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.
Like bladder cancers, UTUCs can develop as low- or high-grade tumours.
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 the kidney does have to be removed if the tumour is too extensive.
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 nephrouretectomy.
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.