Cancer - renal pelvis or ureter

Definition

Cancer of the renal pelvis or ureter is cancer that forms in the pelvis or the tube that carries urine from the kidney to the bladder.

Alternative Names

Transitional cell cancer of the renal pelvis or ureter

Causes, incidence, and risk factors

Cancer can grow in the urine collection system, but is uncommon. As a group, renal pelvis and ureter cancers account for no more than 5% of all cancers of the kidney and upper urinary tract. They affect men more often than women and are more common in people older than 65.

Tumors of the renal pelvis and ureter are usually transitional cell cancers. Approximately 10% are squamous cell carcinomas.

The causes of this cancer are not completely known. Long-term (chronic) irritation of the kidney from harmful substances removed in the urine may be a factor. This irritation may be caused by:

• Analgesic nephropathy
• Exposure to certain dyes and chemicals used to manufacture leather goods, textiles, plastics, and rubber
• Smoking

Patients with a history of bladder cancer are also at risk.

Symptoms

• Back pain, located where ribs and spine meet
• Bloody urine
• Burning, pain, or discomfort with urination
• Dark, rust-colored, or brown urine
• Fatigue
• Flank pain
• Need to urinate frequently at night
• Unintentional weight loss
• Urinary frequency or urgency
• Urinary hesitancy

Signs and tests

A physician will examine the abdomen by touch. Rarely is there a lump (mass) or enlarged kidney. The patient may have blood in the urine. A complete blood count (CBC) may show anemia.

Cancer cells may appear on the following tests:

• Urine cytology (microscopic examination of cells) taken during a cystoscopy
• Urine cytology taken from a urine sample

The tumor, or signs of urinary obstruction, may appear on:

• Abdominal CT scan
• Intravenous pyelogram (IVP)
• Kidney ultrasound
• MRI of abdomen
• Renal scan

An x-ray, CT scan, or MRI of other areas of the body may show that the cancer has spread from the kidneys.

Treatment

The goal of treatment is to eliminate the cancer.

Surgery to remove all or part of the kidney (nephrectomy) is usually recommended. This may include removing part of the bladder and tissues around it, or the lymph nodes. If the tumor is in the ureter, it may be possible to remove it while preserving the kidney.

When the cancer has spread outside of the kidney or ureter, chemotherapy is often used. Because these tumors are similar to a form of bladder cancer, they are treated with a similar type of chemotherapy.

Support Groups

For additional information and resources, see cancer support groups.

Expectations (prognosis)

The outcome varies depending on the location of the tumor and whether the cancer has spread. Cancer that is only in the kidney or ureter can be cured with surgery.

Cancer that has spread to other organs is usually not curable. However, there are exceptions.

Complications

• Kidney failure
• Local spread of the tumor with increasing pain
• Spread of the cancer

Calling your health care provider

Call your health care provider if you have the symptoms listed above.

Prevention

• Follow your health care provider's advice regarding medications, including over-the-counter pain medicine
• Stop smoking
• Wear protective equipment if you may be exposed to substances that are toxic to the kidneys

References

National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Bladder Cancer, Including Upper Tract Tumors and Urothelial Carcinoma of the Prostate. National Comprehensive Cancer Network; 2008. Version 2.2008.