Ureteral Cancer
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Transitional cell cancer of the renal pelvis and ureter is a disease in
which malignant (cancer) cells form in the renal pelvis and ureter.
The renal pelvis is part of the kidney and the
ureter connects the kidney to the bladder. There are 2 kidneys, one on each
side of the backbone, above the waist. The kidneys of an adult are about 5
inches long and 3 inches wide and are shaped like a kidney bean. The kidneys
clean the blood and produce urine to rid the body of waste. The urine collects
in the middle of each kidney in a large cavity called the renal pelvis. Urine
drains from each kidney through a long tube called the ureter, into the bladder,
where it is stored until it is passed from the body through the urethra.
The renal pelvis and ureters are lined with transitional
cells. These cells can change shape and stretch without breaking apart. Transitional
cell cancer starts in these cells. Transitional cell cancer can form in the
renal pelvis or the ureter or both.
Renal cell cancer is a more common type of kidney
cancer. Refer to the PDQ summary on Renal Cell Cancer Treatment for more information.
Misuse of certain pain medicines can affect the risk of developing transitional
cell cancer of the renal pelvis and ureter.
- Misusing certain pain medicines, including over-the-counter pain
medicines, for a long time.
- Being exposed to certain dyes and chemicals used in making leather goods, textiles,
plastics, and rubber.
- Smoking cigarettes.
Possible signs of transitional cell cancer of the renal pelvis and ureter
include blood in the urine and back pain.
These and other symptoms may be caused by transitional
cell cancer of the renal pelvis and ureter or by other conditions. There may
be no symptoms in the early stages. Symptoms may appear as the tumor grows.
A doctor should be consulted if any of the following problems occur:
- Blood in the urine.
- A pain in the back that doesn't go away.
- Extreme tiredness.
- Weight loss with no known reason.
- Painful or frequent urination.
Tests that examine the abdomen and kidneys are used to detect (find) and
diagnose transitional cell cancer of the renal pelvis and ureter.
- Physical exam and history: An exam of the body to check general
signs of health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patientfs health habits
and past illnesses and treatments will also be taken.
- Urinalysis: A test to check the color of urine and its contents, such as sugar,
protein, blood, and bacteria.
- Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check
for abnormal areas. A ureteroscope (a thin, lighted tube) is inserted through
the urethra into the bladder, ureter, and renal pelvis. Tissue samples may
be taken for biopsy.
- Urine cytology: Examination of urine under a microscope to check for abnormal
cells. Cancer in the kidney, bladder, or ureter may shed cancer cells into
the urine.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and
bladder to check for cancer. A contrast dye is injected into a vein. As the
contrast dye moves through the kidneys, ureters, and bladder, x-rays are
taken to see if there are any blockages.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas
inside the body, taken from different angles. The pictures are made by a
computer linked to an x-ray machine. A dye may be injected into a vein or
swallowed to help the organs or tissues show up more clearly. This procedure
is also called computed tomography, computerized tomography, or computerized
axial tomography.
- Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced
off internal tissues or organs and make echoes. The echoes form a picture
of body tissues called a sonogram. An ultrasound of the abdomen may be done
to help diagnose cancer of the renal pelvis and ureter.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the
stage and grade of the tumor.
- The stage and grade of the tumor.
- Where the tumor is.
- Whether the patient's other kidney is healthy.
- Whether the cancer has recurred.
Most transitional cell cancer of the renal pelvis
and ureter can be cured if found early.
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After transitional cell cancer of the renal pelvis and ureter has been
diagnosed, tests are done to find out if cancer cells have spread within the
renal pelvis and ureter or to other parts of the body.
The process used to find out if cancer has spread
within the renal pelvis and ureter or to other parts of the body is called
staging. The information gathered from the staging process determines the stage
of the disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys,
ureters, and bladder to find out if cancer has spread within these organs.
A contrast dye is injected into a vein. As the contrast dye moves through
the kidneys, ureters, and bladder, x-rays are taken to see if there are any
blockages.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas
inside the body, taken from different angles. The pictures are made by a
computer linked to an x-ray machine. A dye may be injected into a vein or
swallowed to help the organs or tissues show up more clearly. This procedure
is also called computed tomography, computerized tomography, or computerized
axial tomography.
- Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced
off internal tissues or organs and make echoes. The echoes form a picture
of body tissues called a sonogram.
- Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check
for abnormal areas. A ureteroscope (a thin, lighted tube) is inserted through
the urethra into the bladder, ureter, and renal pelvis. Tissue samples may
be taken for biopsy.
- Surgery: Tissues removed during surgery to treat the transitional cell cancer
will be examined by a pathologist.
In stage 0, the cancer is found in or on tissue
lining the inside of the renal pelvis or ureter only. Stage 0 is divided into
stage 0a and stage 0is, depending on the type of tumor:
- Stage 0a may look like tiny mushrooms growing from the lining. Stage
0a is also called noninvasive papillary carcinoma.
- Stage 0is is a flat tumor on the tissue lining the inside of the renal pelvis
or ureter. Stage 0is is also called carcinoma in situ.
In stage I, cancer has spread through the cells
lining the renal pelvis and/or ureter, into the layer of connective tissue.
In stage II, cancer has spread through the layer
of connective tissue to the muscle layer of the renal pelvis and/or ureter.
In stage III, cancer has spread:
- to the layer of fat outside the renal pelvis and/or ureter; or
- into the wall of the kidney.
In stage IV, cancer has spread to at least one of
the following:
- A nearby organ.
- The layer of fat surrounding the kidney.
- One or more lymph nodes.
- Other parts of the body.
The cancer is found only in the kidney.
The cancer has spread to tissues around the kidney
and to nearby lymph nodes and blood vessels in the pelvis.
The cancer has spread to other parts of the body.
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Recurrent transitional cell cancer of the renal
pelvis and ureter is cancer that has recurred (come back) after it has been
treated. The cancer may come back in the renal pelvis, ureter, or other parts
of the body.
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Different types of treatments are available for
patients with transitional cell cancer of the renal pelvis and ureter. Some
treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before starting treatment, patients may want to
think about taking part in a clinical trial. A treatment clinical trial is
a research study meant to help improve current treatments or obtain information
on new treatments for patients with cancer. When clinical trials show that
a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.
One of the following surgical procedures may be
used to treat transitional cell cancer of the renal pelvis and ureter:
- Nephroureterectomy: Surgery to remove the entire kidney, the ureter,
and the bladder cuff (tissue that connects the ureter to the bladder).
- Segmental resection of the ureter: A surgical procedure to remove the part of
the ureter that contains cancer and some of the healthy tissue around it.
The ends of the ureter are then reattached. This treatment is used when the
cancer is superficial and in the lower third of the ureter only, near the
bladder.
Other types of treatment are being tested in clinical trials. These include
the following:
Fulguration is a surgical procedure that destroys
tissue using an electric current. A tool with a small wire loop on the end
is used to remove the cancer or to burn away the tumor with electricity.
This is a surgical procedure to remove localized
cancer from the renal pelvis without removing the entire kidney. Segmental
resection may be done to save kidney function when the other kidney is damaged
or has already been removed.
A laser beam (narrow beam of intense light) is
used as a knife to remove the cancer. A laser beam can also be used to kill
the cancer cells. This procedure may be called laser therapy or laser fulguration.
Chemotherapy is a cancer treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by stopping
the cells from dividing. Biologic therapy is a treatment that uses the patient's
immune system to fight cancer; substances made by the body or made in a laboratory
are used to boost, direct, or restore the body's natural defenses against cancer.
Regional treatment means the anticancer drugs or biologic substances are placed
directly into an organ or a body cavity such as the abdomen, so the drugs will
affect cancer cells in that area. Clinical trials are studying the effectiveness
of chemotherapy or biologic therapy using drugs placed directly into the renal
pelvis or the ureter.
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Localized Transitional Cell Cancer of the Renal Pelvis and Ureter
- Surgery (nephroureterectomy or segmental resection of ureter).
- A clinical trial of fulguration.
- A clinical trial of laser surgery.
- A clinical trial of segmental resection of the renal pelvis.
- A clinical trial of regional chemotherapy.
- A clinical trial of regional biologic therapy.
This summary section refers to specific treatments
under study in clinical trials, but it may not mention every new treatment
being studied.
Treatment of regional transitional cell cancer of
the renal pelvis and ureter is usually done in a clinical trial.
Treatment of metastatic transitional cell cancer
of the renal pelvis and ureter is usually done in a clinical trial, which may
include chemotherapy.
Treatment of recurrent transitional cell cancer
of the renal pelvis and ureter is usually done in a clinical trial, which may
include chemotherapy.
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Bladder Cancer
