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Glossary


Cancer of the renal pelvis or ureter

Anatomy

Risks

Early detection

Signs and symptoms

Diagnosis

Pathology and staging

Treatment

Supportive care

 

Renal pelvis cancer starts in the renal pelvis of the kidney. Ureter cancer starts in the ureter. Both the renal pelvis and the ureter are part of the urinary system.

 

Cancers of the renal pelvis and ureter are considered bladder cancers rather than kidney cancers. They are more similar to bladder cancer because the cancer starts in the cells that line the inside of the renal pelvis, ureter and bladder.

 

Specific numbers for cancer of the renal pelvis are not reported separately, but are included with kidney cancer statistics. Only a small percentage (less than 10%) of the new cases of kidney cancer diagnosed in Canada will be renal pelvis cancers.

 

Specific numbers for cancer of the ureter are not reported separately, but are included in the general category, other urinary cancers. This broad category includes similar cancers that are grouped and reported together. The statistics listed do not necessarily reflect the actual incidence for the individual cancers within the group. In 2007 there were 448 new cases of other urinary cancers in Canada.

Anatomy

The kidneys are bean-shaped organs, about 12 cm (4–5 inches) long, 6 cm (2–3 inches) wide and 3 cm (1–2 inches) thick.

 

 

The renal pelvis is a hollow collecting area in the centre of each kidney. The ureters are thin tubes about 25–30 cm (10–12 inches) long that connect the kidneys to the bladder.

 

The renal pelvis and ureter are lined with a layer of urothelial or transitional cells. The lining is called the urothelium or transitional epithelium. This is the same lining that is found in the bladder.

 

 

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Risks

Cancer risk refers to a person’s risk of developing cancer. Any substance or condition that increases the risk of cancer is referred to as a risk factor.

 

Cancer of the renal pelvis or ureter affects more men than women. It is rare in people under the age of 65 years.

 

The most important risk factor for developing cancer of the renal pelvis or ureter is smoking. However, most cancers are the result of many risk factors. The following factors are known to increase the risk of developing cancer of the renal pelvis or ureter:

  • smoking
    • Smoking tobacco is the strongest risk factor for developing cancer of the renal pelvis or ureter.
    • Risk increases with the length of time a person smokes and with the number of cigarettes smoked.
  • heavy use of phenacetin
    • Phenacetin is a type of analgesic, or pain reliever. People who used phenacetin very heavily (3 or more pills per day over a number of years) are at an increased risk of developing renal pelvis or ureter cancer.
    • Medicines containing phenacetin have been banned since the early 1980s, so this is no longer likely to be a major risk factor.
  • Balkan endemic nephropathy
    • Balkan endemic nephropathy (BEN) is a serious kidney disease that occurs only in clusters of rural villages in the valleys of the Danube River in the Balkan Peninsula of Eastern Europe. People with BEN are at an increased risk of multiple tumours in the renal pelvis or ureter, usually in both kidneys and ureters.

 

Arsenic in drinking water is a known risk factor for bladder cancer. It may have some association with cancers of the renal pelvis and ureter since these cancers are very similar to bladder cancer. Further study is needed to clarify the role of arsenic as a risk factor for renal pelvis and ureter cancer.

 

See a list of questions to ask your doctor about risks.

 

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Early detection

Early detection means finding a cancer or precancerous condition at an early stage. In most cases, finding cancer early increases the chances of successful treatment.

 

Recognizing symptoms and getting regular checkups are the best ways to detect cancer of the renal pelvis or ureter early. The sooner symptoms are reported, the sooner a doctor can diagnose and treat the cancer.

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Signs and symptoms

A sign is something that can be observed and recognized by a doctor or healthcare professional (for example, a rash). A symptom is something that only the person experiencing it can feel and know (for example, pain or tiredness).

 

Other health conditions can have the same signs and symptoms as cancer of the renal pelvis or ureter, so having any of the following symptoms does not necessarily mean a person has cancer. However, it is important to see a doctor about:

  • blood or blood clots in the urine
  • pain in the area around the back and side of the abdomen (flank)
  • pain or a burning feeling while urinating
  • difficulty urinating

 

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Diagnosis

Diagnostic tests will be done if the signs and symptoms of renal pelvis or ureter cancer are present or if the doctor suspects renal pelvis or ureter cancer. Tests may include:

  • urinalysis
    • With cancer of the renal pelvis or ureter, urinalysis is used to check for blood in the urine.
  • urine cytology
    • Urine cytology tests the urine for the presence of cancer cells.
    • In cancer of the renal pelvis or ureter, the cancer starts in the cells lining the urinary tract. Sometimes these cells are shed into the urine as it collects in the renal pelvis and passes through the ureter.
  • ureteroscopy
    • This is a type of endoscopy that uses a ureteroscope to examine the ureter and renal pelvis. The ureterocope is inserted through the urethra and passed into the bladder, ureter and renal pelvis.
    • The doctor can examine the entire urinary tract to see if there is a blockage, bleeding or other abnormality.
    • Samples of tissue may be taken using a special brush or small scraping basket, or by rinsing the ureters and renal pelvis with salt water. A pathologist examines these samples in the laboratory.
  • cystoscopy
    • Cystoscopy is an examination of the bladder. It is often done at the same time as ureteroscopy because people diagnosed with renal pelvis or ureter cancer are at higher risk of developing a tumour in the bladder.
  • computed tomography (CT) scan
    • CT scan may be used to diagnose renal pelvis or ureter cancer since it can outline the size, shape and location of the tumour.
  • intravenous pyelography
    • An intravenous pyelography (IVP) is a special x-ray that uses a contrast medium to examine the kidneys, bladder and ureters.
    • It is used to look for tumours or kidney stones.
  • retrograde pyelography
    • This is a series of x-rays of the kidneys and the urinary system done during ureteroscopy.
    • A thin tube (catheter) is threaded through the ureteroscope. Dye is injected through the catheter into the ureter. The dye outlines abnormalities, such as a tumour or blockage, in the ureter and renal pelvis.
    • It is used in people who cannot tolerate the contrast medium used with CT scans.

 

Additional tests, such as CT scan of the abdomen and chest, may be done to determine the stage (how far the disease has progressed).

 

See a list of questions to ask your doctor about diagnostic tests.

 

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Pathology and staging

When renal pelvis or ureter cancer has been diagnosed, tests will be done to find out:

  • the type of renal pelvis or ureter cancer
    • Transitional cell (or urothelial) carcinoma accounts for over 90% of renal pelvis and ureter tumours. These tumours start in the cells lining the inside of the renal pelvis and ureters.
    • Rare tumours include squamous cell carcinoma, adenocarcinoma and sarcomas.
  • the stage of the cancer (how far the cancer has progressed)
    • The stage of renal pelvis or ureter cancer is based on whether or not the cancer has spread:
      • through the lining of the renal pelvis or ureter
      • to the fat surrounding the kidney or to any lymph nodes
      • to other areas of the body
  • the grade of the tumour (how abnormal the cancer cells look and behave)

 

How well the cancer responds to treatment (the prognosis) depends on:

  • the stage of the cancer
    • Tumours of the renal pelvis or ureter that are found at an early stage have a more favourable prognosis than tumours found at an advanced stage.
  • the grade of the tumour
    • Low-grade tumours of the renal pelvis or ureter have a more favourable prognosis than high-grade tumours.
  • other prognostic factors
    • Tumours in several different areas of the urinary tract (multifocal) have a less favourable prognosis.
    • A tumour that is not removed completely by surgery has a less favourable prognosis.

 

This information is used to plan the best treatment for each person with renal pelvis or ureter cancer.

Questions about survival

People with cancer should talk to their doctor about their prognosis. Prognosis depends on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

 

It is difficult to obtain survival statistics for cancers of the renal pelvis and ureter, because both of these rare types of cancer are included in categories with other cancers.

  • Cancers of the renal pelvis are included in the statistics with kidney cancer, but they are very different types of cancer and the prognosis for each will be different.
  • Cancers of the ureter are included with other rare urinary tract cancers, such as tumours of the urethra, so the statistics are not specific to ureter tumours. Statistics do not necessarily reflect the actual incidence and mortality for the individual cancers within the group.

 

See a list of questions to ask your doctor about pathology and staging.

 

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Treatment

Each person with renal pelvis or ureter cancer will have a treatment plan designed for them by their healthcare team. The team will recommend treatment options based on the specific characteristics of the cancer and the unique needs of the person. A treatment plan for renal pelvis or ureter cancer may include one or more of the following.

Surgery

Surgery is the primary treatment for cancer of the renal pelvis or ureter:

  • radical nephroureterectomy
    • This is the most common surgery for cancer of the renal pelvis or ureter. Surgery removes the whole kidney and surrounding fat, the whole ureter and the tissue where the ureter enters the bladder (bladder cuff).
    • The adrenal gland may or may not be removed.
    • Sometimes, lymph nodes in the abdomen on the same side as the tumour may be removed if doctors suspect that cancer has spread to them.
    • With large tumours, the renal vein and parts of the large vein in the abdomen (vena cava) may be removed.
  • segmental resection of the ureter
    • This surgery removes the part of the ureter that contains the tumour along with a margin of healthy tissue above and below the tumour. The 2 remaining ends of the ureter are then joined together.
    • Segmental resection is done only for tumours in the lower third of the ureter.
  • ureteroneocystomy (re-implantation)
    • Ureteroneocystomy is the removal of the lowest part of the ureter and the bladder cuff. The remaining part of the ureter is then joined to the bladder.
    • This surgery is done only if the tumour is in the lowest part of the ureter, near the bladder.
  • percutaneous endoscopic surgery
    • An endoscope is passed through an incision in the back, through the kidney and into the renal pelvis of the kidney. The renal pelvis tumour is then removed with tools passed through the endoscope.
    • This surgery is used to remove tumours that are only in the urothelium (superficial tumours).
    • Percutaneous endoscopic surgery is offered to people who have only one functioning kidney and are not well enough to have a radical nephrectomy.

 

Most surgery for cancer of the renal pelvis or ureter is done with an open incision (laparotomy) in the lower back. Laparoscopic surgery, using a long, flexible tube placed through small incisions into the body to remove the kidney or ureter, may be done in some areas of Canada by surgeons experienced in this technique.

Potential side effects of surgery for renal pelvis or ureter cancer

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way. The most common side effects of surgery are:

  • pain
  • bleeding
  • infection
  • bladder problems
    • spasms
    • urgency
    • frequency
    • blood in the urine
  • narrowing of the ureter (stricture), which can cause a blockage

Chemotherapy

Chemotherapy is used to treat renal pelvis or ureter cancer that has spread to the lymph nodes or to other parts of the body. Adjuvant chemotherapy may be offered after surgery, if cancer is found in the lymph nodes removed during surgery.

 

The drugs used to treat renal pelvis or ureter cancer are the same drugs used to treat bladder cancer. The most common type of tumour in these sites is transitional cell (urothelial) carcinoma, which is the same type of cancer that affects the bladder.

 

The most common chemotherapy combinations used to treat renal pelvis or ureter cancer are:

  • GC – more commonly used because it is less toxic than other combinations
    • gemcitabine (Gemzar)
    • cisplatin (Platinol AQ)
  • MVAC
    • methotrexate
    • vinblastine (Velbe)
    • doxorubicin (Adriamycin)
    • cisplatin

 

Other drugs sometimes used in combination to treat renal pelvis or ureter cancer include:

  • cyclophosphamide (Cytoxan, Procytox)
  • paclitaxel (Taxol)

Potential side effects of chemotherapy for renal pelvis or ureter cancer

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way. Side effects depend on the type of drug(s) used. The most common side effects of chemotherapy are:

 

Note: Other side effects may occur. See specific chemotherapy drug information for more details about individual drug side effects.

Radiation therapy

External beam radiation therapy may be used to relieve pain or to control the symptoms of advanced renal pelvis or ureter cancer (palliative radiation therapy). Renal pelvis or ureter cancer may be treated with external beam radiation therapy. A machine directs radiation to the tumour and some of the surrounding tissue.

Potential side effects of radiation therapy for renal pelvis or ureter cancer

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way. Side effects depend on the amount of radiation given and the area(s) treated. The most common side effects of radiation therapy are:

Follow-up after treatment

It is important to have regular follow-up visits, especially in the first 3 years after treatment.

 

See a list of questions to ask your doctor about treatment.

 

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Supportive care

A cancer diagnosis can lead to many challenges for people with cancer and their families. Each person’s experience will be different because their cancer, treatment and recovery are different. A person with renal pelvis or ureter cancer may be concerned about:

  • living with one kidney
    • A person can live a normal and healthy life with one working kidney, or even part of a kidney. The remaining kidney can filter the waste and excess water from the blood.
    • If you smoke, get help to quit. Smoking is the strongest risk factor for developing renal pelvis or ureter cancer.
    • It’s important to take care of the remaining kidney. If the remaining kidney is not completely healthy, or you have only part of a kidney remaining, talk to a dietitian about changing your diet.
  • dialysis
    • Dialysis removes wastes from the blood in people who do not have working kidneys. Some people with cancer of the renal pelvis or ureter may need dialysis after surgery.
      • Hemodialysis uses a machine to filter the wastes and excess water from the blood.
      • Peritoneal dialysis uses a person’s own body tissues inside the belly (abdominal cavity), along with a special fluid injected into the abdomen. These work together as a filter to remove the wastes and excess water from the blood.

 

See a list of questions to ask your doctor about supportive care after treatment.

 

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References

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