Cancer - renal pelvis or ureter

Definition

The kidneys collect urine in a section called the pelvis. The pelvis and its subdivisions (calyces) empty urine into a tube called the ureter, which leads to the bladder. Cancer can grow in this urine collection system, but is uncommon.

Causes, incidence, and risk factors

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. Chronic (long-term) irritation of the kidney from harmful substances excreted in the urine may be a factor and may result from the following:

• Smoking
• 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.

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, but it rarely reveals a mass or an enlarged kidney. The patient may have blood in the urine. A complete blood count (CBC) may show anemia.

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

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

Treatment

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.

Support Groups

For additional information and resources, see cancer support groups.

Expectations (prognosis)

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.

Complications

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

Calling your health care provider

Call your health care provider if the symptoms listed above are present.

Prevention

Wear protective equipment if you may be exposed to kidney-poisoning substances. Stop smoking. Follow your health care provider's advice regarding use of medications, including over-the-counter pain medicine.

Illustrations

Kidney anatomy

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Transitional cell cancer of the renal pelvis or ureter