Ureter and Renal Pelvis Cancer

Ureter and renal pelvis cancer are types of upper urinary tract urothelial cancers (UTUC). These cancers originate in the urothelial cells that line the inner surface of the ureters and the renal pelvis.

• Ureter Cancer: Affects the ureters, the thin tubes that transport urine from the kidneys to the bladder.
• Renal Pelvis Cancer: Develops in the renal pelvis, the funnel-shaped structure in the kidney where urine collects before moving to the ureters.

These cancers are relatively rare compared to bladder cancer, but they share similar characteristics since all three originate from urothelial cells.

The exact causes of ureter and renal pelvis cancer are not always clear, but several factors can increase the risk, including:

• Smoking: Tobacco contains carcinogens that are excreted through urine, increasing exposure to the urothelial cells.
• Occupational Exposure: Exposure to industrial chemicals, such as those used in dye, rubber, and leather industries.
• Chronic Inflammation: Conditions like chronic urinary tract infections (UTIs) and kidney stones can increase cancer risk.
• Hereditary Factors: People with Lynch syndrome (hereditary nonpolyposis colorectal cancer) have an increased risk.
• Previous Cancer Treatment: Use of chemotherapy drugs like cyclophosphamide and radiation therapy in the pelvic region may raise the risk.

Symptoms of ureter and renal pelvis cancer may not appear in the early stages. As the disease progresses, common symptoms include:

• Blood in the urine (hematuria)
• Pain or discomfort in the lower back or side
• Frequent or painful urination
• Unexplained weight loss
• Fatigue
• Urinary obstruction leading to kidney swelling (hydronephrosis)

Diagnosis involves a combination of imaging, laboratory tests, and biopsy procedures. Common diagnostic methods include:

• Urinalysis: Checks for blood, cancer cells, or abnormal substances in the urine.
• Cystoscopy and Ureteroscopy: Involves inserting a thin, lighted tube through the bladder and ureter to visualize abnormal growths.
• Imaging Tests: CT scans, MRI, and ultrasound can detect tumors or blockages.
• Biopsy: Tissue samples obtained during ureteroscopy or surgery are examined for cancer cells.
• Intravenous Pyelogram (IVP): An X-ray procedure using contrast dye to highlight the urinary tract.

Treatment is determined based on the cancer’s stage, location, and the patient’s overall health.

Surgical Treatment

• Nephroureterectomy: Complete removal of the kidney, ureter, and part of the bladder.
• Segmental Ureterectomy: For localized cancer, removing only the affected portion of the ureter.
• Laser Ablation: Minimally invasive destruction of tumors using laser energy.

Non-Surgical Treatment

• Chemotherapy: Often used before or after surgery to kill cancer cells or prevent recurrence.
• Immunotherapy: Drugs like checkpoint inhibitors may boost the immune system’s ability to fight cancer.
• Radiation Therapy: Used in cases where surgery is not possible or for palliative care.

While not all cancers can be prevented, reducing risk factors can help:

• Quit smoking and avoid exposure to tobacco.
• Minimize exposure to industrial carcinogens.
• Maintain proper hydration to flush toxins from the urinary tract.
• Monitor for symptoms, especially if there is a family history of cancer.

The prognosis depends on several factors, including the stage at diagnosis, the size of the tumor, and response to treatment. Early-stage cancers have a better prognosis, with a five-year survival rate of around 90%. In advanced cases, survival rates are lower.

Living with ureter and renal pelvis cancer may involve:

• Regular follow-ups and imaging tests to monitor for recurrence.
• Supportive care to manage pain and treatment side effects.
• Emotional support through counseling or cancer support groups.
• Dietary adjustments to promote kidney health.

Current research focuses on:

• Targeted Therapy: Developing drugs that specifically target cancer cells with minimal damage to normal cells.
• Immunotherapy: Harnessing the body’s immune system for more effective cancer control.
• Biomarker Research: Identifying genetic markers to predict how patients respond to specific treatments.
• Minimally Invasive Techniques: Robotic and laparoscopic surgeries offer faster recovery and less postoperative pain.

Patients and families can benefit from various resources:

• National Cancer Institute (NCI)
• American Cancer Society (ACS)
• Cancer Support Communities
• Online Patient Forums
• Counseling Services

There are various clinical trials exploring novel therapies and treatment combinations. Enrolling in a trial could give an individual access to state-of-the-art therapy. Websites such as CancerFax and the NCI site offer current information on trial participation.