Upper Tract Urothelial Cancer
Urothelial cancer refers to a cancer of the lining of the urinary system.
The majority of urothelial cancers, approximately 90-95%, arise in the bladder.
Approximately 10% of urothelial cancers arise rise in the upper urinary tract.
Upper tract urothelial cancers (UTUCs) correspond to urothelial cancers that arise in the lining of the kidney called the renal pelvis or the ureter.
Both bladder cancers and UTUCs can present with hematuria blood in the urine.
UTUCs can block the ureter or kidney, hydronephrosis and infections, and they can even affect kidney function in some patients.
UTUCs can develop as low- or high-grade tumors.
In general, low-grade tumors are not invasive and very rarely spread from the kidney or ureter.
UTUCs are frequently low-grade and primarily papillary tumors that are substantially less aggressive than high-grade UTUC‘s and demonstrate a low rate of cancer specific mortality, but hematuria and urinary obstruction are common and require management.
UTUCs often recur and management involves treating visible tumors and trying to preserve the urinary tract.
High-grade tumors have an aggressive appearance under a microscope and are assumed invasive in the kidney or ureter.
High-grade UTUC has the potential to spread from the kidney or ureter and is most often treated with radical nephrouretectomy.
In low grade UTUC‘s kidney spearing approaches such as endoscopic laser ablation confers a similar rate of disease free survival as radical nephrouteterectomy.
Endoscopic approaches are difficult to perform because with narrow ureteral lumen and anatomical complexity of the calyceal system, and the majority of patients have develop recurrent disease requiring additional ablations and repeated anesthesia.
Primary chemo ablation of low-grade upper tract urothelial cancer with intracavitary made mitomycin results in a significant disease eradication and may offer kidney sparing treatment alternative.