What is upper tract urothelial cancer
The urothelium is a specialized mucous membrane lining the inside of the calyces, pelvis, ureter and bladder. Carcinogens that enter the body are excreted in the urine and come into contact with this entire surface, so a tumor can occur on any part of it.
In the upper urinary tract, the tumor grows in a narrow lumen, so it soon causes a violation of the outflow of urine and bleeding. This is both a plus - there is a chance to notice the disease earlier, and a minus - hydronephrosis can mask the process as a benign obstruction.
The key concept is the “field effect”: the entire urothelium is changed, and not just the area with the tumor. Hence the high incidence of relapses in the bladder after treatment of upper tract tumors and the need for long-term follow-up.
Risk factors
- Smoking is the leading and most proven factor
- Professional contact with aromatic amines: production of dyes, rubber, leather, textiles
- Long-term uncontrolled use of painkillers in the past
- Lynch syndrome is a hereditary predisposition; with it, tumors of the upper tract occur at a younger age
- Past bladder cancer
- Chronic inflammation and pelvic stones
- Male gender and age over 60 years
- Chronic kidney disease
Symptoms
- Painless blood in the urine is the most common first sign.
- Lower back pain, usually dull, due to obstruction of urine flow
- An attack similar to renal colic when the ureter is blocked by a clot
- Discharge of worm-like blood clots
- Unilateral hydronephrosis detected on ultrasound
- Recurrent urinary tract infections
- Weight loss, weakness, loss of appetite with a common process
- Palpable formation in the side - for large tumors
Diagnostics
- CT urography with contrast is the main imaging method
- MR urography for iodine contrast intolerance
- Cystoscopy is mandatory to exclude simultaneous bladder tumors
- Ureteroscopy - direct examination of the ureter and pelvis
- Ureteroscopy with biopsy of the formation - morphological confirmation
- Diagnostic nephroscopy for tumors of the pelvis
- Retrograde ureteropyelography - clarification of the level and extent
- Cytological examination of urine, including selectively from the ureter
- Chest CT and prevalence assessment
- Assessing the function of both kidneys is critical for choosing between radical and organ-preserving tactics
Treatment
- Radical nephroureterectomy with resection of the bladder area around the orifice is the standard for high-risk tumors
- Laparoscopic or open surgery depending on extent
- Organ-preserving endoscopic treatment - laser ablation of the tumor through the ureteroscope; used for small low-risk tumors, solitary kidney, bilateral lesions and reduced renal function
- Segmental resection of the ureter with reimplantation - for tumors of the lower third
- Intracavitary administration of drugs into the upper urinary tract
- Systemic chemotherapy before or after surgery for high-risk tumors
- Immunotherapy for advanced disease
- Stenting or nephrostomy to restore urine flow
The choice between radical and organ-preserving tactics is determined by the size, location, degree of malignancy of the tumor, its quantity and, no less important, the condition of the second kidney. The decision is made jointly by the urologist and oncologist.
Observation after treatment
- Regular cystoscopy - relapse in the bladder is common
- Urine cytology
- CT urography for monitoring the upper urinary tract, including the contralateral side
- Monitoring the function of the remaining kidney: creatinine, urine test
- Immediate treatment if blood appears in the urine between routine examinations
- Quitting smoking reduces the risk of relapse
- Genetic counseling and examination of relatives for suspected Lynch syndrome
Where to be examined and treated in Tashkent
CT urography, cystoscopy, ureteroscopy with biopsy capability, and surgical service for nephroureterectomy are required.
In Tashkent, examination for suspected tumors of the upper urinary tract, including ureteroscopy with biopsy and retrograde ureteropyelography, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you had an episode of blood in the urine, and an ultrasound showed dilatation of the pelvis on one side without a stone, do not delay CT urography and consultation with a urologist. Clinic contacts are below on the page.
