Upper Tract Urothelial Cancer (Ureter & Kidney TCC)

What is upper tract Urothelial carcinoma?

  • Upper tract UC is a similar type of cancer as bladder cancer, however it arises either in the ureter (tube connecting kidney to bladder) or within the collecting system of the kidney (calyces or renal pelvis)
  • Compared to bladder cancer, it is much less common

What causes upper tract Urothelial carcinoma?

  • The main risk is smoking. Other risk factors include:
    • Cyclophosphamide exposure
    • Long term inflammation of the ureter/kidney
    • Aniline dyes
  • A history of bladder Urothelial carcinoma increases the risk of upper tract cancer

What are the symptoms of upper tract UC?

  • Haematuria (blood in urine) is the most common symptom. This may be visible or microscopic
  • Other less common symptoms include:
    • Flank pain
    • Mass
    • Urinary tract infections
  • It may also be detected on kidney ultrasound or CT scan

How is upper tract UC diagnosed?

  • Urine analysis – detecting blood
  • Urine cytology – detecting cancer cells in urine
  • Blood tests – checking kidney function
  • X-rays – CT IVP is a dedicated CT scan of the kidneys and ureter which can often detect upper tract cancer
  • Ureteroscopy – ultimately required to diagnose upper tract UC. This involves a small telescope being passed through the bladder and into the ureter. The ureteroscope can be passed all the way to inspect the kidneys collecting system if required.  If possible, a biopsy will be taken to confirm the diagnosis.

What treatment will be required if I have upper tract Urothelial carcinoma?

  • Treatment will be dependant on tumour factors and patient factors
    • Tumour factors include:
      • The location of the tumour (ureter vs. kidney)
      • Grade of tumour (high grade vs. low grade)
      • Size of tumour
      • Patient factors:
        • Health of the other kidney & kidney function
        • Age and other medical conditions of patient
  • Surgery is the most effective treatment option for upper tract UC. Options include:
    • Nephroureterectomy – surgical removal of the kidney and ureter all the way down to the bladder including a cuff of normal bladder tissue.  This is generally the “gold standard” treatment. In most cases, the kidney and ureter can be removed with key hole surgery (laparoscopic).  The bladder end of the ureter may require on open cut to be fully removed or sometimes can be removed at cystoscopy.
    • Distal ureterectomy – surgical removal of the bottom part of the ureter down to the bladder.  This is only possible if the tumour is located in the pelvic part of the ureter.  The kidney is spared and the ureter is re-joined to the bladder.
    • Ureteroscopy and laser of tumour – this minimally invasive option is used in select cases only.  It is generally used for small low grade tumour only and patients who may not be surgical candidates for other options.

What follow up will be required after my treatment?

Patients with upper tract UC are at a significantly increased risk of developing bladder cancer.  For that reason, regular cystoscopy and imaging of the other ureter and kidney will be required for a minimum