Ureteral cancer

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Ureteral cancer
Cystoscopy - Uretereal Cancer.jpg
A cystoscope showing a tumor in the ureters. Here it threatens to completely cut off flow to the ureters.
Specialty Oncology
Urology
Symptoms Blood in the urine

Ureteral cancer is cancer of the ureters, muscular tubes that propel urine from the kidneys to the urinary bladder. It is also known as ureter cancer, [1] renal pelvic cancer, [1] and rarely ureteric cancer or uretal cancer. Cancer in this location is rare. [1] [2] Ureteral cancer becomes more likely in older adults, usually ages 70–80, who have previously been diagnosed with bladder cancer. [3]

Contents

Ureteral cancer is usually a transitional cell carcinoma. [2] [4] Transitional cell carcinoma is "a common cause of ureter cancer and other urinary (renal pelvic) tract cancers." [1] Because the inside of the ureters and the inside of the bladder contain the same cell type, people who have been diagnosed with ureteral cancer are more likely to also be diagnosed with bladder cancer, and vice versa. [3]

Ureteral cancer oftentimes doesn't present with any unusual symptoms until the cancer has progressed. [5] Once the cancer has progressed it often causes hematuria, frequent urination, nocturia, and many other urination problems, as well as unusual weight loss and fatigue. [6] It has not become clear to doctors what specifically causes this disease but there are many well known risk factors, many of which are common to a variety of cancers.

A diagnosis can be made in different ways, but some of the most common diagnostic tools are intravenous pyelography and computed tomography urography. [7] Once a diagnosis is made, there are many different treatment methods, which will be dependent upon the nature of the cancer and the patient's wishes.

Symptoms

Ureter cancer rarely causes problems in the early stages, but as the cancer progresses, there are often side effects. [5] Symptoms of ureteral cancer may include "blood in the urine (hematuria); diminished urine stream and straining to void (caused by urethral stricture); frequent urination and increased nighttime urination (nocturia); hardening of tissue in the perineum, labia, or penis; itching; incontinence; pain during or after sexual intercourse (dyspareunia); painful urination (dysuria); recurrent urinary tract infection; urethral discharge and swelling". [6] Other common symptoms associated with ureteral cancer may include back pain, unexplained weight loss, and unusual fatigue. [3]

Causes and risk factors

The exact causes of ureteral cancer are not clear. However, it is known that patients with a history of bladder cancer are more likely to develop ureteral cancer because both cancers contain the same cell type. As with other cancers, the cells lining the ureter undergo a DNA mutation resulting in abnormal growth of cells without programmed cell death; this eventually leads to blockage of the ureter and possibly other body parts if left untreated. [3]

The risk of developing ureteral cancer increases with age. In addition to increasing age, previous bladder or kidney cancer diagnoses may also increase the risk of developing ureteral cancer. HNPCC (hereditary nonpolyposis colorectal cancer), also known as lynch syndrome, leads to an increased risk of developing ureteral cancer, as well as various other cancers such as colon cancer. [3] Aside from genetic factors and predisposition to developing cancer, there are also a few environmental factors and lifestyle choices that may significantly escalate the chances of being diagnosed with ureteral cancer. For example, taking an overabundance of pain medications such as phenacetin, a probable carcinogen, can lead to an increased risk. Exposure to certain chemicals used to produce leather goods, plastics, rubber, etc. have also been proven to influence the likeliness of developing ureteral cancer. [8] As with many other types of cancer, tobacco smoking is also associated with an increased risk of ureteral cancer. [9]

Diagnosis

Example of an IVU radiograph Ivu 1.jpg
Example of an IVU radiograph

Diagnosis may include a fluorescence in situ hybridization (FISH) test, computed tomography urography (CTU), magnetic resonance urography (MRU), intravenous pyelography (IVP) x-ray, ureteroscopy, [7] or biopsy. Before a diagnosis is made, a physical examination and health history will be conducted. This includes questions related to current signs and symptoms, which are used to better understand the presenting condition. Imaging tests such as CTU and IVP are also frequently used, as well as MRU, which is used if CT imaging is not available or suitable for the patient. [7] A procedure called a ureteroscopy is also used to inspect the ureters. During this procedure a thin, lighted tube equipped with a camera is inserted through the urethra and into the bladder, ureter, and renal pelvis. This can also include a biopsy (small sample of tissues collected), which will then be inspected in the laboratory. Less invasive common testing methods include a urine test, a urine cytology test to look for abnormal cells, as well as a urinalysis to check the color of urine and its contents. [8]

Pathology and staging

There are multiple stages of ureteral cancer: 0, I, II, III, and IV.

Stage 0 can be divided into stages 0a and 0is and occurs when abnormal cells appear in the tissue lining the inside of the ureter. Stage 0a (noninvasive papillary carcinoma) is when long, thin growths extend from the tissue lining the ureter. Stage 0is (carcinoma in situ) is a flat tumor located on the tissue lining.

Other classifications of transitional cell cancer of the ureter include localized, regional, metastatic, and recurrent. [8] Localized means that the cancer has remained at the point of origin (ureter). Regional indicates that the cancer has spread to tissues, lymph nodes, or blood vessels in the vicinity. Metastatic cancer means that it has spread to other parts of the body. Recurrent means that the cancer has returned after treatment has been completed; this can occur in the same location or other parts of the body. [10]

Treatment and management

Treatment methods include surgery, [1] [11] chemotherapy, [1] radiation therapy [1] and immunotherapy. [1] Treatment options vary based on the size and location of the tumor, how aggressive the cancer cells are, and the patient's lifestyle and expectations. [1]

After a diagnosis of ureteral cancer, surgery is oftentimes recommended to help remove the infected ureter. For early stage ureteral patients, removing only a portion of the ureter can be successful, whereas in more advanced cases full removal of the ureter as well as the associated kidney (nephroureterectomy) and part of the bladder is sometimes necessary. [1] In less advanced cases where the cancer is only on the surface of the ureter, electrosurgery or laser therapy may be performed to remove the affected cells. Electrosurgery uses an electric current, whereas laser therapy involves passing a ureteroscope through the bladder and into the urethra where a beam of the laser is used to destroy the cells. [3]

Chemotherapy has many different uses in treating ureteral cancer. Prior to surgery, chemotherapy is sometimes used to help shrink the tumor so that it can be more easily removed. Chemo may also be used in more advanced cases to control the symptoms and side effects of the cancer. [1] After surgery to remove the tumor, a single dose of chemotherapy injected into the bladder is helpful in reducing the rate of cancer recurrence in people who have cancer of the inner lining of the bladder (upper tract urothelial carcinoma). [12] Serious side effects don't seem to be increased by chemotherapy. [12]

Advanced ureteral cancer cases may often be treated with immunotherapy when other treatment methods are not successful. Immunotherapy uses the body's own immune system to fight the cancer by helping the immune system to recognize these cancer cells as foreign. [1]

Epidemiology

Between 1988 and 2001 in the United States, cancer surveillance reports to the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute included 1,333 cases of ureteral cancer in adults: 808 male and 525 female, 1,158 white and 42 black. "Five-year relative survival rates from cancers of the ureter were similar among males vs. females..." [2] Of the total, 1,251 (94%) were transitional cell carcinoma of the papillary type. [2] It has been determined that transitional cell carcinoma is twice as common in Caucasian men when compared to African-American men. As mentioned by the National Cancer Institute, most cases of ureter cancer occur in the US, Canada, Northern Europe, Australia, and New Zealand. Less common areas for ureter cancer diagnosis are Thailand, China, and the Philippines. [5]

See also

Related Research Articles

<span class="mw-page-title-main">Urethra</span> Tube that connects the urinary bladder to the external urethral orifice

The urethra is a tube that connects the mammalian urinary bladder to the urinary meatus in the glans penis or vulval vestibule. Male and female placental mammals release urine through the urethra during urination, but males also release semen through the urethra during ejaculation.

<span class="mw-page-title-main">Bladder</span> Organ in vertebrates that collects and stores urine from the kidneys before disposal

The bladder is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In placental mammals, urine enters the bladder via the ureters and exits via the urethra. In humans, the bladder is a distensible organ that sits on the pelvic floor. The typical adult human bladder will hold between 300 and 500 ml before the urge to empty occurs, but can hold considerably more.

<span class="mw-page-title-main">Urinary system</span> Anatomical system consisting of the kidneys, ureters, urinary bladder, and the urethra

The human urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH. The urinary tract is the body's drainage system for the eventual removal of urine. The kidneys have an extensive blood supply via the renal arteries which leave the kidneys via the renal vein. Each kidney consists of functional units called nephrons. Following filtration of blood and further processing, wastes exit the kidney via the ureters, tubes made of smooth muscle fibres that propel urine towards the urinary bladder, where it is stored and subsequently expelled from the body by urination. The female and male urinary system are very similar, differing only in the length of the urethra.

<span class="mw-page-title-main">Cystoscopy</span> Medical procedure; endoscopy of the urinary bladder via the urethra

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.

<span class="mw-page-title-main">Ureter</span> Tubes used in the urinary system in most animals

The ureters are tubes composed of smooth muscle that transport urine from the kidneys to the urinary bladder. In an adult human, the ureters typically measure 20 to 30 centimeters in length and about 3 to 4 millimeters in diameter. They are lined with urothelial cells, a form of transitional epithelium, and feature an extra layer of smooth muscle in the lower third to aid in peristalsis. The ureters can be affected by a number of diseases, including urinary tract infections and kidney stone. Stenosis is when a ureter is narrowed, due to for example chronic inflammation. Congenital abnormalities that affect the ureters can include the development of two ureters on the same side or abnormally placed ureters. Additionally, reflux of urine from the bladder back up the ureters is a condition commonly seen in children.

<span class="mw-page-title-main">Bladder cancer</span> Urinary system cancer that begins in the urinary bladder

Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become malignant.

<span class="mw-page-title-main">Kidney cancer</span> Medical condition

Kidney cancer, also known as renal cancer, is a group of cancers that starts in the kidney. Symptoms may include blood in the urine, a lump in the abdomen, or back pain. Fever, weight loss, and tiredness may also occur. Complications can include spread to the lungs or brain.

<span class="mw-page-title-main">Hematuria</span> Medical condition

Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.

<span class="mw-page-title-main">Transitional epithelium</span> A type of tissue

Transitional epithelium is a type of stratified epithelium. Transitional epithelium is a type of tissue that changes shape in response to stretching. The transitional epithelium usually appears cuboidal when relaxed and squamous when stretched. This tissue consists of multiple layers of epithelial cells which can contract and expand in order to adapt to the degree of distension needed. Transitional epithelium lines the organs of the urinary system and is known here as urothelium. The bladder, for example, has a need for great distension.

<span class="mw-page-title-main">Hydronephrosis</span> Medical condition

Hydronephrosis describes hydrostatic dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream. Alternatively, hydroureter describes the dilation of the ureter, and hydronephroureter describes the dilation of the entire upper urinary tract.

<span class="mw-page-title-main">Hemorrhagic cystitis</span> Medical condition

Hemorrhagic cystitis or haemorrhagic cystitis is an inflammation of the bladder defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage. The disease can occur as a complication of cyclophosphamide, ifosfamide and radiation therapy. In addition to hemorrhagic cystitis, temporary hematuria can also be seen in bladder infection or in children as a result of viral infection.

<span class="mw-page-title-main">Vesicoureteral reflux</span> Medical condition

Vesicoureteral reflux (VUR), also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into one or both ureters and then to the renal calyx or kidneys. Urine normally travels in one direction from the kidneys to the bladder via the ureters, with a one-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1–2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too "end-on".

<span class="mw-page-title-main">Ureteral stent</span> Medical device

A ureteral stent, or ureteric stent, is a thin tube inserted into the ureter to prevent or treat obstruction of the urine flow from the kidney. The length of the stents used in adult patients varies between 24 and 30 cm. Additionally, stents come in differing diameters or gauges, to fit different size ureters. The stent is usually inserted with the aid of a cystoscope. One or both ends of the stent may be coiled to prevent it from moving out of place; this is called a JJ stent, double J stent or pig-tail stent.

Pyelogram is a form of imaging of the renal pelvis and ureter.

<span class="mw-page-title-main">Transitional cell carcinoma</span> Medical condition

Transitional cell carcinoma, also called urothelial carcinoma, is a type of cancer that typically occurs in the urinary system. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus. Symptoms of urothelial carcinoma in the bladder include hematuria. Diagnosis includes urine analysis and imaging of the urinary tract (cystoscopy). Transitional cell carcinomas arise from the transitional epithelium, a tissue lining the inner surface of these hollow organs. When the term "urothelial" is used, it specifically refers to a carcinoma of the urothelium, meaning a transitional cell carcinomas of the urinary system.

<span class="mw-page-title-main">Urethral cancer</span> Medical condition

Urethral cancer is a rare cancer originating from the urethra. The disease has been classified by the TNM staging system and the World Health Organization.

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.

Bladder outlet obstruction occurs when urine is unable to flow from the kidneys through the ureters and out of the bladder through the urethra. Decreased flow of urine leads to swelling of the urinary tract, called hydronephrosis. This process of decreased flow of urine through the urinary tract can begin as early as during intrauterine life and it prevents normal development of fetal kidneys and fetal urine. Low levels of fetal urine leads to low amniotic fluid levels and incomplete lung maturation. Older children and adults can also experience bladder outlet obstruction; however, this process is usually reversible and isn't associated with as many poor outcomes as in infants with congenital bladder outlet obstruction.

<span class="mw-page-title-main">Invasive urothelial carcinoma</span> Medical condition

Invasive urothelial carcinoma is a type of transitional cell carcinoma. It is a type of cancer that develops in the urinary system: the kidney, urinary bladder, and accessory organs. Transitional cell carcinoma is the most common type of bladder cancer and cancer of the ureter, urethra, renal pelvis, the ureters, the bladder, and parts of the urethra and urachus. It originates from tissue lining the inner surface of these hollow organs - transitional epithelium. The invading tumors can extend from the kidney collecting system to the bladder.

<span class="mw-page-title-main">Renal ultrasonography</span> Examination of one or both kidneys using medical ultrasound

Renal ultrasonography is the examination of one or both kidneys using medical ultrasound.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 Ureter Cancer, Mayo Clinic
  2. 1 2 3 4 Ries LG, Young JL, Keel GE, Eisner MP, Lin YD, Horner MJ, eds. (2007), "Chapter 30: Cancers of Rare Sites", SEER Survival Monograph: Cancer Survival Among Adults: US SEER Program, 1988-2001, Patient and Tumor Characteristics, SEER Program, vol. NIH Pub. No. 07-6215, Bethesda, MD: National Cancer Institute, pp. 251–262, archived from the original on 10 October 2013, retrieved 18 October 2013
  3. 1 2 3 4 5 6 "Ureter Cancer | UC Irvine Health | Department of Urology". www.urology.uci.edu. Retrieved 28 October 2021.
  4. ↑ Transitional Cell Cancer (Kidney/Ureter), National Cancer Institute
  5. 1 2 3 "Introduction to Kidney & Ureter Cancer | SEER Training". training.seer.cancer.gov. Retrieved 9 November 2021.
  6. 1 2 Urethral Cancer, Department of Urology, University of Miami Leonard M. Miller School of Medicine
  7. 1 2 3 Ureter Cancer Diagnosis, Mayo Clinic
  8. 1 2 3 4 "Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)–Patient Version - National Cancer Institute". www.cancer.gov. 20 February 2004. Retrieved 28 October 2021.
  9. ↑ McCredie M, Stewart JH, Ford JM (July 1983). "Analgesics and tobacco as risk factors for cancer of the ureter and renal pelvis". The Journal of Urology. 130 (1): 28–30. doi:10.1016/s0022-5347(17)50936-2. PMID   6864908.
  10. ↑ "Articles". Cedars-Sinai. Retrieved 9 November 2021.
  11. ↑ Ureteral Cancer, Fox Chase Cancer Center
  12. 1 2 Hwang EC, Sathianathen NJ, Jung JH, Kim MH, Dahm P, Risk MC, et al. (Cochrane Urology Group) (May 2019). "Single-dose intravesical chemotherapy after nephroureterectomy for upper tract urothelial carcinoma". The Cochrane Database of Systematic Reviews. 5: CD013160. doi:10.1002/14651858.CD013160.pub2. PMC   6525634 . PMID   31102534.
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