Cancer - renal pelvis or ureter
Cancer of the renal pelvis or ureter involves the growth of cancerous cells in the collection system of the kidney. This includes the part of the kidney (the pelvis and its subdivisions or calyces) that empties urine into the ureter, which leads to the bladder.
Causes, incidence, and risk factors
As a group, renal pelvis and ureter carcinomas are uncommon and account for no more than 5% of all cancers of the kidney and upper genitourinary tract. They affect men more commonly 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. Chronic irritation of the kidney from harmful substances excreted in the urine may be a factor and may result from the following:
- Analgesic nephropathy
- Exposure to aniline dyes and chemicals used in the manufacturing of leather goods, textiles, plastics, and rubber
Patients with a previous history of bladder cancer are also at risk.
- Back pain, located where ribs and spine meet
- Bloody urine
- Burning, pain, or discomfort with urination
- Dark, rust-colored, or brown urine
- Flank pain
- Need to urinate frequently at night
- Unintentional weight loss
- Urinary frequency or urgency
- Urinary hesitancy
Signs and tests
Examination by touch (palpation) of the abdomen rarely reveals a mass or an enlarged kidney.
- Blood in the urine may appear.
- Complete blood count (CBC) may show anemia.
Cancer cells may appear on the following tests:
- Urine cytology (microscopic examination of cells) obtained during a cystoscopy
- Urine cytology obtained from a urine sample
The tumor, or signs of urinary obstruction, may appear on:
- Intravenous pyelogram (IVP)
- Kidney ultrasound
- Abdominal CT scan
- MRI of abdomen
- Renal scan
An x-ray, CT scan, or MRI of other areas of the body may show metastasis of cancer from the kidneys.
The goal of treatment is to eliminate the cancer.
Surgical removal of all or part of the kidney (nephrectomy) is usually recommended. This may include removal of part of the bladder and surrounding tissues or 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 behave similarly to transitional cell carcinoma of the bladder, the chemotherapy regimens used are similar to those used for bladder cancer.
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group.
The outcome varies depending on the exact location of the tumor and whether the cancer has metastasized. Cancer localized to the kidney or ureter can be cured with surgery.
Cancer that has metastasized to other organs is usually not curable, though there are exceptions.
- Local spread of the tumor with increasing pain
- Metastasis of the cancer
- Renal failure
Calling your health care provider
Call your health care provider if the symptoms listed above are present.
Wear protective equipment if exposure to nephrotoxic (kidney-poisoning) substances is likely. Stop smoking. Follow your health care provider’s advice regarding use of medications, including over-the-counter analgesics.
by Potos A. Aagen, M.D.