Renal pelvis and ureter cancers

Gross hematuria is presenting symptoms in 75-90% of patients with tumors of the renal pelvis and ureters.

Upper tract urolthelial cancers account for 5-10% of all urothelial cancers.

Diagnosed in fewer than 3000 patients annually in the U.S.

90% of cases are transitional cell carcinomas, while squamous cell cancer account for 10% of malignancies.

Primary ureters tumors occur in about half the frequency of renal pelvis cancers.

Usually treated with ureteronephrectomy.

Radical nephroureterectomy with excision of bladder cuff is the gold standard of treatment for most patients with upper tract urothelial cancers.

The benefits of lymph node dissection is controversial.

Survival related to pathological stage with 100% survival for noninvasive tumors Ta and Tis and 41% for T3 disease.

When tumor extends beyond the muscularis 5 year survival rates range from 0-34%.

In transitional tumors distant metastases occur more commonly than local relapse.

Overall local or regional failure rates range from 2-27% in various studies.

T3 disease associated with local failure 50% of the time, and 60% with high grade lesions (Cozad).

Most studies report an association between local failure and distant metastases.

Chemotherapy and radiation compared to radiation alone associated with a lower rate of local failure (22% vs. 45%) and a higher 5 year survival (67% vs., 27%) (Ozsahin).

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