Upper Tract Tumor

The most common type of cancer that develops in the renal pelvis and ureter is Urothelial carcinoma or Upper tract cancer. In the upper tract, cancer may be papillary or nodular, muscle-invasive or non-invasive. Upper tract cancers may range from small benign tumors to aggressive abnormal growth of cells. Upper tract Urothelial cancer generally occurs at the lining of the urinary system.

Upper tract urothelial cancers (UTUCs) are a subset of urothelial cancers:

• Renal pelvis cancer originates in the lining of the kidney, ureter, or renal pelvis area, where urine is stored before it travels to the ureters and bladder.
• Renal calyces cancers occur deep in the kidneys
• Ureter cancer starts in the layer of tissue that lines the bladder and the upper urinary tract called the urothelium. Tumors originate in the ureter or renal pelvis and are collectively called upper tract urothelial cancers (UTUCs).

Urothelial cells make the lining of the urethra, bladder, ureters, renal pelvis, and other nearby organs. These cells are highly elastic and change shape without breaking apart. It is also called transitional cells. Bladder cancer starts inside the lining of the bladder which is made up of urothelial cells.

UTUCs can develop low-grade tumors or high-grade tumors. Low-grade tumors confined in the kidney and ureter. High-grade tumors are fast-growing and spread from the kidney or ureter to other parts of the body. If it gets worst, the surgical removal of the kidney or ureter is the only option left and, in most cases, it is followed by chemotherapy.

When the malignant cancer cells grow in the bladder or in the ureter, the following symptoms appear:

• Presence of blood or blood clots in the urine.
• Persistent pain in the lower back, side, or stomach.
• The frequent urge of urination and most often it is painful urination
• Fatigue and weight loss

An exact cause is not identified but there are certain risk factors such as:

• Gender: Urothelial cancers are diagnosed more commonly in men than in women
• Race: Upper urinary tract cancer is most commonly found in white than African-Americans
• Lifestyle Factors: Cigarette smoking and the uses of tobacco are the major cause of urothelial cancer
• Exposure to organic chemicals, toxins, rubber, paint, dye, coal, and tar increase the risk of urothelial cancers.
• Medications: Long-time use of painkillers, analgesics, and certain herbs increases the risk of renal pelvis and urothelial tract cancers.
• Family history of urinary tract cancers people is at high risk of urothelial cancers.
• Chronic urinary tract inflammation, bladder infection, urinary tract stones are closely associated with renal pelvis cancers.

The initial evaluation of cancer in a patient is done through a physical examination to check for signs of the disease.

• Urinalysis is done to check your urine for the presence of blood, protein, and any infection.
• Ultrasound and CT scan to check any lumps in kidney, bladder, and abdomen.
• To see tumors more clearly, MRI and X-rays are used with dye to scan the abdomen, pelvis, and lymph nodes and detect local extension of cancer.
• A cystoscopy can be used to look through the urethra, into the bladder and urinary tract.
• A sample tissue of the renal pelvis or ureter can be used to diagnose the stage of cancer in biopsy

Current treatments for upper tract cancer/urothelial carcinoma include:

Surgery

The standardized treatment for upper urinary tract cancers is nephroureterectomy. It involves the removal of the kidney, ureter, and bladder tissue depending on tumor size, tumor location, and tumor aggressiveness. If there are multiple tumors, removing nearby lymph nodes and tissue are also included. Laparoscopic and endoscopic surgery targets the tumor cell in the ureter and the kidney and destroys it. Segmental resection removes the affected part of the urinary tract that contains the tumor. Radical and partial cystectomy is preferred for high-grade invasive bladder cancer.

Chemotherapy

Systemic chemotherapy is used to treat upper urinary tract cancer after the removal of the kidney and ureter. Immunotherapy is used in bladder cancer, to prevent cancer from coming back.

Radiation

Radiation is used on selective patients with bladder cancer when cystectomy or surgical treatment is not possible. Radiation therapy can be used for renal pelvic and ureteral cancers if cancer is extended to lymph nodes. High-energy radiation destroys cancer cells with the preservation of nearby organs from damaging. Though, it is rarely used for treating urothelial tumors until the preservation of nearby tissue is not possible by other methods.

After treatment, you will need to continue to follow up as upper urinary tract cancer is more likely to reoccur in multiple places.