Cancer - renal pelvis or ureter

Definition

Cancer of the renal pelvis or ureter is cancer that forms in the kidney's pelvis or the tube that carries urine from the kidney to the bladder.

Alternative Names

Transitional cell cancer of the renal pelvis or ureter

Causes, incidence, and risk factors

Cancer can grow in the urine collection system, but is uncommon. As a group, renal pelvis and ureter cancers account for about 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. Long-term (chronic) irritation of the kidney from harmful substances removed in the urine may be a factor. This irritation may be caused by:

• Analgesic nephropathy
• Exposure to certain dyes and chemicals used to manufacture leather goods, textiles, plastics, and rubber
• Smoking

Patients with a history of bladder cancer are also at risk.

Symptoms

• Back pain, most often where ribs and spine meet
• Bloody urine
• Burning, pain, or discomfort with urination
• Dark, rust-colored, or brown urine
• Fatigue
• Flank pain
• Unintentional weight loss
• Urinary frequency or urgency

Signs and tests

The health care provider will perform a physical exam, and examine your belly area (abdomen). In rare cases, this may reveal an enlarged kidney.

• Urinalysis may show blood in the urine.
• A complete blood count (CBC) may show anemia.
• Urine cytology (microscopic examination of cells) taken during a cystoscopy or urine clean catch sample may reveal cancer cells.

The following tests may be done:

• Abdominal CT scan
• Chest x-ray
• Cystoscopy with ureteroscopy
• Intravenous pyelogram (IVP)
• Kidney ultrasound
• MRI of abdomen
• Renal scan

These tests may reveal a tumor or show that the cancer has spread from the kidneys.

Treatment

The goal of treatment is to eliminate the cancer.

Surgery to remove all or part of the kidney (nephrectomy) is usually recommended. This may include removing part of the bladder and tissues around it, or the 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 are similar to a form of bladder cancer, they are treated with a similar type of chemotherapy.

Support Groups

For additional information and resources, see cancer support groups.

Expectations (prognosis)

The outcome varies depending on the location of the tumor and whether the cancer has spread. Cancer that is only in the kidney or ureter can be cured with surgery.

Cancer that has spread to other organs is usually not curable. However, there are exceptions.

Complications

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

Calling your health care provider

Call your health care provider if you have the symptoms listed above.

Prevention

• Follow your health care provider's advice regarding medications, including over-the-counter pain medicine.
• Stop smoking.
• Wear protective equipment if you may be exposed to substances that are toxic to the kidneys.

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References

Bajorin DF. Tumors of the kidney, bladder, ureters, and renal pelvis. In Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 203.

National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Bladder cancer. 2012. Version 2.2012.