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Masson-Lecomte A, Gontero P, Birtle A, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma. Updated April 2024. Accessed July 15, 2024. https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma
Definition, Etiology, Pathogenesis
Cancers of the upper urinary tract originate in the transitional epithelium of the urinary tract (urothelium) and account for ~5% of all kidney tumors.
Hematuria is the most common symptom (>75% of patients). Urinary retention (due to a clot or tumor) causes renal colic.
Urinalysis shows microscopic or macroscopic hematuria with resulting anemia seen in blood tests; urine cytology is sometimes sufficient to establish diagnosis. Ultrasonography may show a kidney mass or hydronephrosis. Standard urography or ascending pyelography reveal poor opacification of the renal pelvis or ureter, or hydronephrosis. Contrast-enhanced computed tomography (CT) shows small tumors of the renal pelvis and lymph node or distant metastases. Ureteroscopy enables tumor visualization and sample collection for histologic examination. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT is performed to assess lymph nodes.
Other causes of hematuria (see Hematuria) or hydronephrosis.
Nephroureterectomy (removal of the entire kidney, ureter, and a portion of the bladder at the ureteric orifice) together with removal of adjacent lymph nodes. In selected patients (eg, tumor in a single remaining kidney), kidney-sparing surgery or ureterectomy is performed. In advanced disease or relapse, chemotherapy, radiation therapy, or immunotherapy (pembrolizumab, atezolizumab) is administered.
