Cancers of the ureter and renal pelvis make up only seven percent of all renal cancers (cancers of the kidneys). They mainly affect people older than 65 years, and are more common in men than in women. These cancers grow out of the transitional epithelium (urothelium), which is the lining of the conduits that carry urine from the kidneys (ureters, urethra, bladder, and renal pelvis). Of all the risk factors for transitional cell carcinoma, smoking is the biggest, as well as working with certain chemicals used in industry such as arsenic, paint, rubber, textile/dye, aluminum, and metal production.
The most prominent symptoms of this disease are blood in the urine and pain in one side of the back. Other symptoms may appear if the tumour blocks the flow of urine from the kidney. These symptoms can include loss of appetite, weight loss, fatigue, fever, night sweats, or a cough.
The first line of inquiry to diagnose transitional cell carcinoma of the ureter or renal pelvis will be blood and urine testing. The physician will want to check kidney and liver function, as well as blood cell count and urine cytology for abnormal cells. If cancer is suspected, other tests might follow, such as:
- Cystoscopy, a type of endoscopy used to visualize the inside of the bladder.
- Ureteroscopy, also a type of endoscopy that enables the physician to visualize the ureters and search for a lesion to biopsy.
- CT urography takes a series of detailed X-rays of the entire urinary system.
- MRI scan gives a very detailed picture of the organs and structures visualized.
- Intravenous pyelogram (IVP), whereby a radioactive substance is injected into the blood and accumulates in the urine, providing a clearer picture of the urinary system under X-rays.
The diagnosis of transitional cell carcinoma is followed by grading and staging of the disease. Grading refers to how abnormal the cells are in relation to benign cells. Staging takes into consideration how far the cancer has spread. In stage 0 to 1, the cancer is localized to the ureter or renal pelvis. In stage 2, there is spread to the muscle layer, and in stages 3 and 4 the spread is beyond the muscle and into the fat layer, the kidney tissue, or other organs.
Treatment for cancer of the ureter and renal pelvis will depend on the stage it has reached, but surgery is usually the first line of action. A nephroureterectomy is the complete removal of the kidney, the renal pelvis, the ureter, and the bladder cuff (section of the bladder adjacent to the ureters).
As the stages advance, chemotherapy and radiotherapy will be administered. Adjuvant chemotherapy is when the drugs are administered after surgery, whereas neo-adjuvant is before surgery. Radiotherapy is only used as palliative treatment in advanced stages of these cancers.