Cancers of the renal pelvis and ureters are usually urothelial carcinoma and occasionally squamous cell carcinomas. Symptoms include hematuria and sometimes pain. Diagnosis is by CT, cytology, and sometimes biopsy. Treatment is surgery.
Lynch syndrome and may be the presenting cancer.
Symptoms and Signs of Renal Pelvic and Ureteral Cancers
Most patients present with hematuria; dysuria and urinary frequency may occur if the bladder also is involved. Colicky pain may accompany obstruction (see Obstructive Uropathy). Uncommonly, hydronephrosis results from a renal pelvic tumor.
Diagnosis of Renal Pelvic and Ureteral Cancers
Ultrasonography or CT with contrast
Cytology or histology
In patients with unexplained urinary tract symptoms, typically ultrasonography or CT with contrast is done. If the diagnosis cannot be excluded, cytologic or histologic analysis is done for confirmation. Ureteroscopy is done when biopsy of the upper tract is needed or when urine cytology is positive but no source of the malignant cells is obvious. Abdominal and pelvic CT and chest x-ray are done to determine tumor extent and to check for metastases.
Treatment of Renal Pelvic and Ureteral Cancers
Excision or ablation
Posttreatment surveillance with cystoscopy
Periodic surveillance cystoscopy is indicated because renal pelvic and ureteral cancers tend to recur in the bladder, and such recurrence, if detected at an early stage, may be treated by fulguration, transurethral resection, or intravesical instillations. Management of metastases is the same as that for metastatic bladder cancer.
Prognosis for Renal Pelvic and Ureteral Cancers
Prognosis depends on depth of penetration into or through the uroepithelial wall, which is difficult to determine. Likelihood of cure is > 90% for patients with a superficial, localized tumor, but is 10 to 15% for those with a deeply invasive tumor. If tumors penetrate the wall or distant metastases occur, cure is unlikely.
Key Points
Do ultrasonography or CT with contrast if urinary tract symptoms are unexplained.
Confirm the diagnosis histologically.
Excise or ablate tumors, usually using radical nephroureterectomy, and monitor patients with periodic cystoscopy.
