The kidneys collect urine, which empties into two tubes called the ureters, which in turn lead to the bladder. Although cancer of the ureter and/or renal pelvis is rare, when it does occur it affects mainly men, and usually people over the age of 65.
Ureter and renal pelvic cancer most often originate in transitional cells, which are cells in the lining of the bladder. A small percentage of ureter cancers, approximately 10 percent, start in the squamous cells, flat cells in the outer layer of the skin, that line the respiratory and digestive tracts, and hollow organs.
Causes and Risk Factors for Ureter Cancer
Although the cause of ureter cancer is unknown, smoking most likely increases risks, as does exposure to a variety of chemicals and dyes found in factories that make leather goods, textiles, plastics, and rubbers. A previous history of bladder cancer also increases risk.
Symptoms of Ureter Cancer
Symptoms for cancer of the ureter include:
- Weight loss (unintentional)
- Dark urine
- Urinary frequency and/or urgency
- Pain or burning discomfort during urination
- Urinary hesitancy
- Pain at the juncture of ribs and spine
- Blood in urine
- Blood clots in urine
- Cramps or back pain
Diagnosing Ureter Cancer
A mass or an enlarged kidney cannot be detected by examining the abdomen by touch. A combination of blood tests, urinalysis, ultrasound, and imaging scans help a physician make a diagnosis. These diagnostics include:
- Abdominal CT scan
- Abdonimal MRI
- Blood test
- Intravenous pyelogram (IVP)
- Kidney ultrasound
- Renal scan
Stages of Ureter Cancer
The stages of ureter cancer are determined by the size of the malignancy and whether or not the cancer cells have spread past the ureter or renal pelvis.
Localized cancer remains at the point of origin, and has not spread beyond the kidney or
ureter. Regional cancer has progressed into the tissue surrounding the kidney and/or
neighboring lymph nodes, while metastatic cancer has invaded other parts of the body.
Treating Ureter Cancer
The criteria for deciding on a course of treatment for ureter cancer includes the patient's age and overall health, in addition to the type of tumor, its grade, stage and position.
Surgical procedures for the treatment of ureter cancer include:
Nephrectomy: complete kidney is removed or, whenever possible, only part of it. This is the most common treatment option. I
Nephro-ureterectomy: removal of the kidney, ureter and upper bladder. If necessary, the adjacent lymph glands, tissue and fat may also be removed.
Segmental ureterectomy resection: If the tumor is small and localized, it is possible to remove only the part of the ureter that contains cancer cells.
Ureteroneocystomy (reimplantation): If the cancer cells are only in the lower part of the ureter, only the lower part is removed, and the remaining section of the ureter is reconnected to the bladder.
If the cancer is detected in its early stages, or if cancer cells appear only on surface of the ureter, laser or electrosurgery are options.
- Laser therapy: A ureteroscope (tube with a lens on one end) is inserted through the bladder into the ureter. A beam of intense laser sent through the tube destroys the tumor.
- Electrosurgery: Tumor is destroyed by an electric current, and adjacent tissue is burned away.
After surgery, radiation therapy and chemotherapy is usually prescribed to eliminate any remaining cancer cells and reduce the possibility of recurrence.
Follow-up appointments to monitor recovery and the potential for recurrence will be necessary. These usually include a physical examination, urine and blood tests, and regular cystoscopies to detect any changes in the ureter.