Urinary Tract Cancer
Upper tract urothelial carcinoma (UTUC), also known as urinary tract cancer, is a malignant neoplasm that originates in the urothelial lining from the renal pelvis to the ureters, at their entry into the bladder.
Although it is less common than bladder urothelial carcinoma, it shares similar histological characteristics. Risk factors such as smoking and exposure to certain chemical substances increase the likelihood of developing this disease.
Symptoms
The most common symptoms of UTUC include:
- Hematuria (blood in the urine): it is the predominant symptom, present in approximately 70–80% of cases.
- Lower back or flank pain: occurs in 20–40% of patients, usually due to obstruction of the ureter by the tumor.
- Palpable mass in the lumbar region: detected in 10–20% of cases, indicating more advanced disease.
Diagnosis
The diagnostic process for UTUC includes:
- CT (Computed Tomography): it is the reference imaging test for evaluating the upper urinary tract and allows the identification of suspicious lesions.
- Urinary cytology: analysis of a urine sample to detect cancer cells.
- Cystoscopy: examination of the bladder to rule out concomitant tumors in the lower urinary tract.
Source: European Association of Urology
- Ureteroscopy: an endoscopic procedure that allows direct visualization of the inside of the ureter and renal pelvis, obtain biopsies, and assess the extent of the tumor.
Source: European Association of Urology
Treatment
The therapeutic approach depends on the location, stage, and grade of the tumor, as well as the patient’s overall condition. The options include:
- Radical nephroureterectomy: surgical removal of the affected kidney, the entire ureter, and a portion of the bladder where the ureters enter. It is the standard treatment for high-grade or invasive tumors.
- Conservative treatments: in selected cases of low-grade, non-invasive tumors, less invasive techniques such as endoscopic resection or laser ablation may be considered, thereby preserving the kidney.
- Systemic chemotherapy: indicated in cases of advanced or metastatic disease, or as neoadjuvant therapy before surgery in locally advanced tumors, or adjuvant therapy in tumors with a high risk of recurrence.
