Upper Tract Urothelial Cancer

Dr. Bimal Bhindi, MD, CM, MSc., FRCSC, Urologic Oncologist

Duration: 4 minutes and 38 seconds

Upper Tract Urothelial Cancer is a type of cancer that occurs in the lining of the upper urinary tract, which includes the renal pelvis (the part of the kidney where urine collects before moving to the ureter) and the ureters (the tubes which carry urine from the kidneys to the bladder). The "urothelium" is the lining of these organs, and when cancer starts here, it's called urothelial cancer. Upper tract urothelial cancer is like bladder cancer, as both types of cancer arise from the urothelial cells.

Upper tract urothelial cancer can present with several symptoms. The most common and often the first sign is blood in the urine (hematuria), which can make the urine look pink, red or dark brown. Some people experience pain or discomfort in the back or side where the affected kidney is located. Frequent or painful urination may also be a symptom.

When someone has these symptoms, they should see their primary care provider immediately. If upper tract urothelial cancer is suspected, your doctor may recommend several tests including urine studies to check for infection and cytology (to look for cancer cells). Additional imaging tests may include an ultrasound to detect abnormalities in the kidneys and ureters and often a CT Scan. If there are concerns on these tests, patients are then usually referred to a urologist. A urologist would want to take a look into the urinary tract. This involves a cystoscopy where a thin tube with a camera is inserted into the bladder to look for any abnormal areas. If upper tract disease is suspected, the urologist will also use the camera to look into the ureters (called a ureteroscopy). Samples (biopsies) may also be taken if needed.

The treatment for UTUC depends on factors like the stage, grade, and location of the cancer, as well as your overall health. Treatment options include surgery which is the most likely treatment for localized cancer. A nephroureterectomy is removal of the affected kidney and ureter. This can be done through open surgery or minimally invasive techniques (laparoscopy or robotic surgery). If the tumor is small, only a part of the ureter may be removed, and that surgery is called a segmental ureterectomy. For smaller, less aggressive tumors, a surgeon might use a scope to remove the tumor without removing the entire kidney or ureter.

In addition to surgery, depending on the stage and grade of the cancer, some patients may require systemic therapy (medications that go throughout the body). Chemotherapy may be used before or after surgery to reduce the risk of recurrence. Immunotherapy is medication that helps your immune system to fight cancer may also be an option. For advanced upper tract urothelial cancer that has spread, this is typically considered incurable and treatments are aimed at controlling the cancer. The treatment options are the same as we what we use for advanced bladder cancer.

After treatment, regular follow-up is essential because UTUC can recur or develop in other parts of the urinary tract, including the bladder. Follow-up care usually includes regular imaging tests to monitor for new tumors as well as cystoscopies to check the bladder for signs of cancer. Urine tests would also be done intermittently.

To summarize, the treatment options for upper tract cancer might be a little bit different compared to what we do for bladder cancer. Usually, surgery is one of the primary modalities followed by systemic therapy with chemotherapy or immunotherapy. It is important to follow the recommendations from your medical team as this cancer is often treatable and curable. Regular follow-up is also important to monitor for disease recurrence and catch it early.

Presenter: Dr. Bimal Bhindi, Oncologist, Calgary, AB

Local Practitioners: Oncologist