Upper Tract Cancer Treatment

What is Upper Tract Cancer?

Upper Urinary Tract Cancer or Tumours are cancers that develop in the renal collecting system (pelvis or calyx) where the kidney collects urine or ureter (drainage tube that carries urine between the kidneys and the bladder).

Upper Tract Cancers are rare and comprise 5% of urothelial cancers (mostly bladder cancer). They are more common in men and their occurrence increases the risk of developing bladder cancer (up to 40%).

What are the risk factors?

Risk factors are similar to ones for bladder cancer but ones notable or more specifically linked to upper tract urothelial cancer include arsenic exposure in drinking water and consumption of aristolochic acid in Chinese herbs as well as patients with Lynch syndromes.

Upper Tract Cancer Treatments

Treatment for Upper Tract Tumours can include:

  • Kidney sparing surgery for low risk cancer
  • Ablative therapy with ureteropyeloscopy and laser
  • Segmental resection
  • Distal Ureterectomy and Reimplant/Ureteral Reconstruction (Psoas Hitch, Boari Flap)
  • Radical Nephroureterectomy for high risk cancer (Significant extent and aggressiveness – high stage and grade)
  • Gold standard for upper tract urothelial cancer – Removal of kidney, with its surrounding fat as well as your ureter with a “cuff” of bladder wall (on the site and extent of the tumour)
  • Can be performed using Open, Laparoscopic or Robotic approach
  • Traditionally a large incision is made over the lower abdomen for removal of the lower ureter with the bladder cuff but with the advent of robotic technology a separate incision can be avoided.
  • Chemotherapy or immunotherapy (neoadjuvant or adjuvant therapy)
  • Radiotherapy – mainly for palliation