Understanding upper tract urothelial cancer

A leading consultant urologist helps us to understand upper tract urothelial cancer, including symptoms, diagnosis and treatment.

What is upper tract urothelial cancer?

Upper tract urothelial cancer (UTUC) is a type of cancer that develops in the lining of the upper urinary tract, which includes the renal pelvis (the area where urine collects in the kidney) and the ureter (the tube that carries urine from the kidney to the bladder). This lining, known as the urothelium, is the same tissue found in the bladder, which is why UTUC is related to bladder cancer.

UTUC is relatively uncommon, accounting for about 5–10% of all urothelial cancers. It typically affects adults, with higher risk in those over 60, and tends to occur slightly more often in men than in women.

What are the symptoms of UTUC?

UTUC often presents with symptoms that may overlap with other conditions of the urinary system, so it’s important to seek medical advice if you experience any of the following:

• Haematuria (blood in the urine): This is the most common symptom of UTUC. The blood may be visible, making the urine appear pink, red, or brown, or it may only be detected during a urine test.
• Flank pain: Pain on one side of the lower back or abdomen can occur if the cancer causes a blockage in the ureter.
• Unexplained weight loss or fatigue: These can sometimes be signs of advanced cancer.
• Recurrent urinary tract infections (UTIs): Persistent or recurrent UTIs may also be a warning sign.

These symptoms aren’t exclusive to UTUC, but they should not be ignored.

Who is at risk?

Several factors can increase the risk of developing UTUC. The most common risk factor is smoking, as tobacco contains chemicals that are filtered by the kidneys and can damage the urothelium. Another significant risk is exposure to certain workplace chemicals, particularly in industries such as dye manufacturing or rubber production.

People with a history of bladder cancer are also more likely to develop UTUC. Additionally, a rare genetic condition called Lynch syndrome (which predisposes individuals to several cancers) is associated with a higher risk.

How is UTUC diagnosed?

If your doctor suspects UTUC, they may start with imaging tests such as a CT urogram or MRI scan to get detailed pictures of the urinary tract. Another important diagnostic tool is ureteroscopy, a procedure where a thin, flexible tube with a camera is inserted into the urinary system to examine the lining and take tissue samples (biopsies).

Urine cytology, where urine is analysed under a microscope for abnormal cells, can also help in the diagnosis.

What are the treatment options?

The treatment of UTUC depends on factors such as the size, location, and stage of the tumour (how far it has spread). Common options include:

• Surgery: For localised cancer, the affected kidney and ureter may be removed in a procedure called a nephroureterectomy. In some cases, minimally invasive techniques may allow partial removal.
• Endoscopic procedures: For smaller or low-grade tumours, surgery via a ureteroscope may be sufficient to remove the cancer without taking out the kidney.
• Chemotherapy or immunotherapy: For advanced cancer, medications may be used to target cancer cells throughout the body.

Your healthcare provider will discuss the best approach tailored to your specific case. Detecting and treating the condition early are crucial for achieving better outcomes.