Introduction
A type of cancer that affects the lining of the urinary system is called urothelial cancer. The ureter or the kidney's lining are the sites of upper tract urothelial cancers (UTUCs), a subset of urothelial cancers, although most urothelial cancers develop in the bladder. One of the symptoms of UTUCs is hematuria, or blood in the urine. For high-grade UTUC, the standard treatment is a surgery called radical nephroureterectomy. This means removing the entire kidney and ureter.
What is Upper Tract Urothelial Carcinoma?
A rare kind of cancer of the kidney or ureter lining is called upper tract urothelial carcinoma. Formerly, it was known as kidney or ureter transitional cell carcinoma (TCC) because transitional cells are where it begins. Each of the body's many cell types has a specific function. The bladder, urethra, ureters, and renal pelvis are lined with transitional cells. These cells can stretch and change shape, implying that certain body components can swell to either store or allow urine to pass through them.
What Are the Causes and Risk Factors of UTUC?
Most of the time, the reason for UTUC is unknown. Nonetheless, there are several risk factors:
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Consuming tobacco.
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History of chronic kidney disease.
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Exposure to specific chemicals over time, including those used in producing rubber, paint, textiles, plastics, and colors.
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Exposure to arsenic.
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Previous radiation or chemotherapy for a different cancer.
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Prolonged use of high dosages of medications.
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Bladder cancer in the family.
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Having Balkan nephropathy (it is a chronic kidney disease that causes kidney failure).
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Lynch syndrome (non-polyposis colorectal cancer) is an inherited condition.
What Are the Symptoms of UTUC?
Early detection of upper tract urothelial cancer can be challenging, and if the cancer is slow-growing, you might not experience any symptoms.
Some persons may have the following symptoms:
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You might notice blood in your urine. It could be a lot or just a little.
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A kidney or ureter blockage brings on back discomfort on one side.
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Loss of weight.
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Infections of the urinary tract.
How is UTUC Diagnosed?
Your physician will review your medical history, conduct a physical examination, and schedule a series of tests if they suspect UTUC.
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Urine Test
Urine cytology, a procedure used to check for cancer cells, may also need you to gather urine samples over three days.
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Blood Test
Blood tests assess your liver and kidney function and monitor your white blood cells, red blood cells, and platelets.
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Ultrasonography
This can provide images of your internal organs using sound waves.
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Computed Tomography Scan
Your body's inside is scanned by specialized devices to produce images. Before the scan, you might receive a dye injection into your veins to improve the clarity of the images.
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MRI
An MRI (magnetic resonance imaging) scan can reveal the extent of any tumors and create comprehensive cross-sectional images of your body.
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PET Scan
During a positron emission tomography (PET) examination, modest doses of radioactive glucose are administered to the body. When scanned, cancer cells seem brighter.
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Ureteroscopy and Cystoscopy
A ureteroscopy looks up into the ureter to the kidney, whereas a cystoscopy looks into the bladder. While a ureteroscopy is typically conducted under general anesthesia, a cystoscopy is typically performed under local anesthesia.
Staging and Grading of UTUC
To create the optimal treatment plan for you, your doctor will need to know the grade and stage of the tumor if any tests reveal cancer cells. The stage explains how big it is and if it has spread outside its original location.
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Stage 0, often known as TA or TIS: A tumor that only affects the mucosa or upper lining is referred to as stage 0, TA, or TIS. This happens in 31 percent of patients with upper tract urothelial carcinoma.
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Stage 1: The first stage affects 25 percent of patients. The tumor invades both the lamina propria and the mucosa. The basement membrane, the lamina propria, is home to numerous lymphatic and blood vessels. It may spread if the tumor is left untreated for a long time or if it is an aggressive strain.
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Stage 2: Stage 2 urothelial carcinoma of the upper tract that has spread to the muscles. The ureter's or the renal pelvis' muscular lining is also invaded by tumors, mucosa, and lamina propria.
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Stage 3: Twenty-four percent of patients had stage 3 cancer. The lamina propria, muscle, and mucosa are all involved. The cancer may develop from the renal pelvis into the kidney or grow from the ureter or the fat surrounding the renal pelvis.
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Stage 4: Local organs may be affected by stage 4 upper tract urothelial cancer. It will be classified as locally progressed or stage 4 upper tract urothelial carcinoma if it spreads to lung or retroperitoneal lymph nodes. Approximately 6 percent of patients experience this.
Treatment Options for UTUC
The optimum course of treatment for your cancer will depend on its type, location, grade, and stage, as well as your age, level of fitness, and overall health.
1. Surgery
The best treatment for UTUC is surgery. Surgery can be done openly or through a keyhole. The location and stage of the tumor determine how much surgery will be required.
2. Chemotherapy
Chemotherapy is the process of using medications to either kill or slow the growth of cancer cells. Your condition and the tumor's stage will determine how you are treated. Chemotherapy for UTUC can be given either before or following surgery. Nephroureterectomy surgery, a procedure in which the kidney and ureter are removed, occasionally involves injecting a single dose of chemotherapy "wash" into the bladder. Usually administered through a catheter kept in place for one to two weeks following surgery, this medication is termed Mitomycin. By doing this, the likelihood of bladder cancer reoccurring can be decreased.
3. Immunization
Immunotherapy for UTUC may be an option if your cancer has spread and is now classified as advanced or metastatic upper urothelial carcinoma. Immunotherapy works by boosting your immune system to attack cancer cells. A new class of immunotherapy medications called checkpoint inhibitors helps the body identify and combat cancer.
4. Radiation Treatment, or Radiotherapy
Radiation therapy, sometimes called radiotherapy, kills cancer cells by using high-energy X-rays. For UTUC, however, radiation therapy is less frequently utilized.
5. Palliative Treatment
In certain instances of urothelial carcinoma of the upper tract, your healthcare team may discuss palliative care with you. Without attempting to cure cancer, palliative care seeks to enhance your quality of life by reducing its symptoms.
Surgical Treatments for UTUC
For UTUC, surgery is the most successful course of treatment. The procedure can be done openly or through a keyhole. There are benefits to each approach in specific circumstances. The tumor's location and stage determine how much surgery is required.
Your surgeon will discuss the kind of operation you might require and could involve:
1. Nephroureterectomy: Removal of the entire kidney and ureter, including the kidney, the fat layer surrounding it, and the ureter down to the bladder. The bladder cuff, a region of tissue where the ureter enters the bladder, is also removed. To see if any cancer cells are present, the surgeon might additionally remove a few local lymph nodes.
2. Distal Resection: This involves removing a portion of the ureter, which includes the bottom portion that extends to the bladder. Only if the tumor is located in the pelvic portion of the ureter is this feasible. The kidney is spared, and the ureter is rejoined to the bladder.
3. During Ureteroscopy: The surgeon inserts a tiny tube into the bladder, ureter, and renal pelvis using a camera (ureteroscope). Tissue samples are frequently taken out (biopsied) for additional microscopic inspection.
4. Percutaneous Renoscopy: Percutaneous endoscopy surgery is exclusively utilized for low-grade and early-stage malignancies. The surgeon creates a tiny cut in your mid-back and inserts a tiny tube into your kidney to reach the renal pelvis while using an endoscope, which is a camera. Using instruments passed through the endoscope, the tumor is removed.
Mild postoperative bleeding and discomfort, infection risk, urine leaks, or issues peeing following surgery are typical side effects.
Prognosis for UTUC
In most cases, UTUC cannot be prevented because the causes of UTUC are unknown. However, you can lower your risk of developing UTUC by stopping smoking, limiting your exposure to certain chemicals, and avoiding using significant amounts of medicines. Tumor grade and stage are the primary prognostic variables. The prognosis for upper urinary tract UCs infiltrating the muscle is not good.
Conclusion
The term "upper urinary tract urothelial carcinoma," or "UTUC," describes malignancies of the ureter, renal pelvis, or renal calyces. The ureter, renal pelvis, and renal calyces move urine from the kidney to the bladder. UTIs are comparatively rare, making up just 5 to 10 percent of all malignancies of the urinary tract. To develop UTUC, smoking is one of the most significant risk factors. The risk rises with the quantity and length of smoking and seems to go down as smoking is stopped. When UTUC has not progressed outside of the urinary system, surgery is typically the primary treatment.
Key Takeaway/A Note from iCliniq:
Upper tract urothelial carcinoma (UTUC) is a type of cancer that can develop in the bladder, ureter, urethra, or inner lining of the kidney. Chemotherapy, radiation therapy, and surgery are the major treatments for UTUC. These treatments can be administered separately or in combination. Tumor grade and stage are the primary prognostic variables. For more information or to consult a specialist on iCliniq.
