Upper tract urothelial cancers (UTUC)
CONDITION
Like in the bladder, the inner surface of the upper urinary tracts (kidneys and ureter) is lined by a layer of cells called urothelium. Cancers that arise from the urothelium of the upper tracts may be known as UTUC. Although this is a similar disease process to most bladder cancers, UTUC is a much rarer disease than bladder cancer, can be more difficult to diagnose and to treat and can carries a risk of earlier spread outside of the urinary tract.
UTUCs are often found incidentally in patients who are undergoing scans for other reasons. Patients with symptoms may experience blood in the urine, pain in the back or loin or may notice a lump in the lower back.
A diagnosis of UTUC can be confirmed with a urine test to look for abnormal cells. If these are not present you may need to have a diagnostic ureteroscopy in order to visualise the urothelium and take biopsies, if required.
If a diagnosis of UTUC is confirmed you will need further scans to check that the disease has not spread outside of the urinary tract (metastasis).
Small, solitary low grade UTUCs may be managed endoscopically. This involves passing a ureteroscope into the ureter or kidney and removing the tumour with laser. Patients undergoing endoscopic management of their UTUC will require surveillance ureteroscopies at regular intervals.
UTUCs that are larger, multi-focal (there is more than one tumour) or are high grade are treated with nephroureterectomy (surgery to remove the kidney and an entire ureter).
You may also need chemotherapy – either before or after surgery – to give you the best outcomes from your UTUC.