TUMORS OF THE RENAL PELVIS & URETERS
A tumor of the renal pelvis and ureter is a malignant tumor which usually originates in the cells forming the inner lining of the renal pelvis and ureter.
Incidence
- Renal pelvis-ureter cancers are rare
- They account for 1-2% of all urinary tract cancers
- They usually develop during the 6th and 7th decade of life
- They are more common in men than women; with a ratio of 3:1
Risk factors
A renal pelvis-ureter cancer has the same risk factors as bladder cancer:
- Smoking
- Occupational exposure to aromatic amines (8 times the risk)
- Analgesic abuse, especially phenacetin
- Chemotherapy with cyclophosphamide
- Chronic inflammation
- Balkan endemic nephropathy
- Genetic factors
Symptoms
Ranked by frequency, they may manifest as follows:
- Macroscopic hematuria: it is the most common symptom (60-70% of cases)
- Colicky pain (30-40% of cases)
- In advanced metastatic diseases: anorexia, loss of weight and bone pain
Diagnosis
The investigation process should always include:
- Lab tests
- CT or MRI scan of the urinary tract
- Cystoscopy (to rule out bladder cancer)
- Urine cytology examination
- In case of doubt or with a solitary kidney, flexible ureteroscopy and biopsy specimens are required
Treatment
Surgical treatment.
The kidney is removed along with the ureter.
In special cases, renal pelvis-ureter cancer can be treated:
- Endoscopically with ureteroscopy–laser-assisted resection
- Partial surgical resection of the ureter