Upper Tract Urothelial Cancer (UTUC)

  • Uncommon
  • May occur together with bladder cancer or may occur alone
  • Risk factors include
    • Personal history of bladder cancer
    • Smoking
    • Consumption of Aristolochic acid
      • Aristolochia plants
      • Aristolochia-based herbal remedies
Upper Tract Urothelial Cancer (UTUC)
Type of Cancer

The upper urinary tract (internal lining of the kidney and ureter) is lined with the same lining as the bladder. For this reason, the type of cancers that occur here are the same as for bladder cancer.

  • 95% are urothelial carcinomas
Stage of Cancer: How Far Has it Gone?

Just like all other cancers, the answer to the question is based on the international TNM classification system. The key questions for UTUC include:

  • Where is the cancer?
  • Is the bladder also involved?
  • Has it gone beyond the wall of the ureter into the surrounding fat or the kidney?
  • Has the cancer spread to the lymph nodes?
  • Has the cancer spread to other organs of the body?

This information will largely be obtained from the scans that are done prior to your treatment.

What Investigations Will I Require Prior to Treatment?

Important information will need to be gathered before a treatment plan can be established. Some of the tests required will include:

  • Blood test – especially to check your kidney function
  • Imaging studies
    • CT scan of the chest, abdomen and pelvis – to determine stage of disease
    • Nuclear Medicine scan – to quantify function of each kidney. This scan is not always required.
    • Occasionally PET scan is required
  • Biopsy – is often required and if so will be obtained endoscopically. Your Urologist will be able to discuss this with you.
  • Inspection of the bladder with a camera (cystoscope): this is often done at the time that the cancer is first diagnosed
What Are My Treatment Options?

There are several options available but not all will be suitable for your needs. Your Urologist will be able to advise you which would be the most appropriate for you. A brief summary of each of the available options is included below.

  • Surgical – is the mainstay of treatment of UTUC
    • Nephro-ureterectomy
      • Is the gold-standard treatment
      • Surgical removal of the involved ureter and kidney
    • Endoscopic
      • Laser of the cancer
      • Is only appropriate in very specific cases (low grade and low volume disease that is endoscopically accessible) and will require close endoscopic surveillance thereafter
    • Systemic
      • Chemotherapy and Immunotherapy
        • Often used before or after nephro-ureterectomy
        • Is also used for cancer that has spread to the lymph nodes or other organs of the body
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